Over 47% of family members who care for a relative with Alzheimer?s disease or a related dementia (ADRD) engage in physical or psychological abuse or neglect. Cross-sectional studies report caregiver stress and behavioral symptoms of dementia are correlated with elder abuse and neglect (EAN), making the caregiver burden theory the leading explanation for EAN. Our pilot work found that the causal pathway between caregiver burden and EAN may only hold true under certain situations with evidence that the subtypes of EAN (physical abuse, psychological abuse, neglect) are enacted through different mechanisms. This suggests that the caregiver burden theory may not wholly explain EAN by ADRD family caregivers, and that other explanations offered for family violence (power and control, social learning, ecological frameworks) may explain EAN in situations when the caregiver burden theory does not. Accordingly, our project will develop a more nuanced understanding of how, when and for whom the caregiver burden theory does apply and identify alternative explanations for when the burden theory does not fit our data. To achieve our goal of understanding the contextual-dependency of modifiable risk and protective factors in predicting EAN events within ADRD family caregiving, our prospective observational cohort study will employ an innovative multi-time series design with three measurement periods over the course of a year. English and Spanish speaking family caregivers of those with ADRD or mild cognitive impairment (N=760) will complete surveys to capture long-term patterns in health and wellbeing at intake, month 6 and 12. Immediately following each time point, participants will complete 21daily diary surveys to capture varying daily dynamics of caregivers? experiences. We will use multi-level models (HLM) to account for the daily observations in three follow up periods nested in people.
In aim 1, we will evaluate the direct and interaction effects of various daily dynamics (care and non-care related stressors, contextual moderators) in predicting EAN events, testing hypotheses offered by the caregiver burden theory.
In aim 2, using the 6-month measures we will evaluate the effects of various long-term patterns in health and wellness, testing hypotheses offered by the caregiver burden theory. We will also test for cross-level interactions consistent with the ecological framework.
In aim 3, using data collected at intake we will examine the extent to which person-level attributes predict EAN events, testing hypotheses offered by the caregiver burden, social learning and power and control theories. Finally, because the ecological framework suggests that these theories are not mutually exclusive, we will test for cross-level interactions in this 3-level HLM to predict EAN events. The study findings will significantly impact the field, by laying the groundwork for further intervention development to support ADRD caregivers and care recipients, and serving as a methodological model for understanding EAN in other contexts. The framework will inform intervention strategies on multiple levels, spanning from individualized person-centered approaches to public health programming and policy.

Public Health Relevance

This project will examine the nature and the timing of risk and protective factors for elder abuse and neglect, as they occur in the everyday life of dementia family caregivers. Combining daily diaries with periodic assessments of health and wellness we will test theory-based hypotheses to identify predictors of abuse and neglect both on a given day, as well as changes in abuse and neglect use over time. Findings from this study will serve as a contextual framework that can guide future intervention development.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZAG1)
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Gerald, Melissa S
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University of Texas Health Science Center
Schools of Nursing
San Antonio
United States
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