Homer and Gilleard (1990) found that among caregivers referred to a respite service, abusive ones scored higher on a depression scale. In a recent study, Williamson and Shaffer (2001) conducted structured interviews with 142 spousal caregivers regarding “potentially harmful behaviors”; these 10 items included verbal aggression, threats, and physical violence. Multivariate analyses found that more depressed caregivers were also more likely to treat their dependent spouses in potentially abusive ways. This finding is also supported by Fulmer and Gurland (1996). Of course, it is possible that depressed individuals may be more likely to report their own behavior as abusive. All of these studies were retrospective; prospective research will be needed to establish the causal direction.

In the only study to distinguish between abuse types, Reay and Browne (2001) found that physical abusers scored significantly higher on a depression scale than did perpetrators of neglect; thus, there may be a difference by type of mistreatment, which needs to be assessed in future research.


A study of a sample of Alzheimer’s disease caregivers found that abusive caregivers (a category that combined “emotional and/or physical abuse”) scored higher on a hostility scale (Quayhagen et al., 1997).

Alcohol Abuse

Several studies of elder mistreatment suggest that alcohol abuse on the part of perpetrators was relatively common. For example, Greenberg and colleagues (1990) reviewed 204 substantiated cases of elder abuse; 44 percent were identified as having alcohol or drug abuse problems. Case-control studies have supported this assertion, finding that elder mistreaters were disproportionately more likely to be identified as having an alcohol use problem (Bristowe and Collins; 1989; Homer and Gilleard, 1990; Wolf and Pillemer, 1989).

In a study funded by the National Institute on Aging that directly addressed this issue, Anetzberger et al. (1994) compared a group of 23 adult children identified by agencies as perpetrators of domestic violence against an elderly parent with a group of 39 nonviolent caregiving children. Both alcohol use and abuse were more common among the perpetrators; for example, daily alcohol consumption was more than twice as likely among perpetrators.

It is possible that the role of alcohol abuse may differ by abuse type. Reay and Browne (2001) found that alcohol abuse by the caregiver (consumption of over 21 units of alcohol per week) occurred in seven out of nine of the physical abuse cases, but only one of the neglect cases.

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