Elderly, sick or disabled men and women who rely primarily on their spouse for care are more likely to be to be screamed at, threatened or otherwise subjected to potentially harmful behaviors than those whose care is not provided by a spouse, new study findings show.

Spouse caregivers are also more likely to subject their infirm husbands and wives to such behavior when they are themselves sick or when their spouse has many care needs.

“Elderly people taking care of a sick spouse are at higher risk of committing verbally and emotionally abusive acts when the spouse needs high levels of help and when the caregiver…is in poor health,” study author Dr. Scott R. Beach, of the University of Pittsburgh, told AMN Health.

“The stress and strain of caregiving can wear a person down to the point where the quality of care they provide is compromised,” he added.

Beach and his colleagues studied 265 elderly care recipients and their caregivers to determine factors associated with potentially harmful caregiver behavior. In general, caregivers provided unpaid help with various activities of daily living and provided primary care for an impaired family member 60 years of age or older who lived in the community.

Overall, about one in four patients (26 percent) said they were subjected to potentially harmful behavior at least sometimes. The most prevalent caregiver behavior involved verbal interactions such as screaming, swearing or using a harsh tone of voice.

Less commonly reported caregiver behaviors included threats to send patients to a nursing home, threats to abandon the patient, threats to use physical force and actual physical force such as hitting, shaking or other rough handling.

Seniors were at greatest risk for being subjected to such behaviors when their primary caregiver was their husband or wife, Beach and his team report in this month’s Journal of the American Geriatrics Society. The likelihood that such potentially harmful behavior would be exhibited was eight times higher when the caregiver was the spouse than when he or she was not married to the patient.

Beach and his team did not investigate the reason for this finding, but he speculates it may be partly due to the great amount of time these couples spend together.

“I think the simple fact that elderly spouses are together most or all of the time provides greater opportunity for such negative interaction,” he said. “Another possibility is that such negative interaction patterns were present in the marriage prior to the caregiving situation.”

“Finally,” he added, “elderly caregivers are simply more susceptible to cognitive, physical, and emotional decline - which put them at risk - than an adult child caregiver.” In other findings, patients’ risk of being subjected to potentially harmful behavior also increased when they needed help with more daily living activities, such as bathing themselves, eating, or personal grooming, when their caregiver had greater cognitive impairment and when their caregiver had an increasing number of headaches, vision problems, leg swelling or other physical symptoms.

Further, when caregivers were at risk for clinical Depression, as were 27 percent of those involved in the study, their patients were more than three times more likely to experience potentially harmful behavior, study findings indicate.

In light of the findings, physicians and other health care workers who care for elderly patients, as well as family members of such patients, “need to be attentive to signs that the caregiver is cognitively, physically, or mentally impaired,” Beach said.

And, he added, “potential caregivers need to be aware of the variety of services that are available to help them help their disabled or sick relative.”

“Get help,” Beach advised. “Don’t try to do it all by yourself, especially if you feel yourself getting sick or stressed.”

SOURCE: Journal of the American Geriatrics Society, February 2005.