Pillemer and Suitor’s (1992) finding that Alzheimer’s caregiver violence is strongly related to experience of violence from the care recipient, and Compton et al.’s (1997) finding that behavior problems are related to both verbal and physical abuse. It may be that dementia itself is not the risk factor, but rather disruptive behaviors that result from dementia. Such an explanation would be consistent with research that has shown disruptive behaviors by Alzheimer’s disease patients to be an especially strong cause of caregiver stress. Future research of the relationship between dementia and elder mistreatment should differentiate the cognitive, functional, and behavioral effects of dementia and examine the independent association between each and the risk for elder mistreatment.
Intraindividual theories of mistreatment locate the causes of abuse in some pathological characteristic of the abuser, usually mental illness, personality characteristics, or alcohol or drug abuse. This approach has a lengthy history in the study of child and intimate partner abuse, including a long-standing debate over the role of intraindividual factors as risk factors for the forms of mistreatment. In the field of elder mistreatment, there is compelling evidence that certain characteristics of perpetrators constitute major risk factors for elder mistreatment, with surprising unanimity on this issue among studies using different methods.
Wolf and Pillemer (1989) found that 38 percent of abusers in three related samples had a history of mental illness and 39 percent had alcohol problems. Reis and Nahmiash (1998) attempted to validate a screening tool using a sample of 341 agency cases in which caregivers could be interviewed. The cases were classified as “likely” or “not likely” to involve abuse of the care recipient. They found that the caregivers’ mental health and behavior problems were strong predictors of likely abuse. Pillemer and Finkelhor (1989) found in a case-comparison study that abusers were substantially more likely to have experienced psychiatric hospitalization than nonabusers.
These studies did not differentiate particular forms of mental illness. Several studies have specifically pointed to depression as characteristic of perpetrators of elder mistreatment. Paveza et al. (1992), in their study of Alzheimer’s caregivers, found that caregiver depression predicted physical abuse. Coyne et al. (1993) compared physically abusive and nonabusive caregivers who called into a telephone helpline for family members of Alzheimer’s disease patients; abusive caregivers were more depressed.