When older people are violent or abusive toward their family caregiver: a review of mixed-methods research

What happens when family caregivers experience violence and abuse from the older person for whom they care? Though this issue has received little global attention, it is of relevance to researchers, practitioners and policy-makers working across the intersecting fields of older age care and medicine, adult protection and safeguarding, and domestic and intimate partner violence (IPV). To date, these fields have generated diverse explanations of what violence and abuse in older age illness is (and is not) and how to respond to it. This paper reports the findings of a systematic literature review of eighteen quantitative, qualitative and mixed-methods studies that investigated violent and abusive behavior by older people towards their family caregivers. The review identified three central themes in the literature: 1) There are inconsistent definitions and measurements used to research harmful, violent and abusive behavior towards family caregivers. 2) Violent and abusive behavior towards caregivers is a sensitive and hidden topic across. 3) There is some evidence to suggest that people who were violent and abusive in their earlier life - or who had a poor relationship with their family member in the past - are more likely to continue to experience violence and abusive behavior in later life. There were two central ways in which violence and abuse were conceptualised and investigated: as a ‘symptom of illness’ or as an ‘act of abuse’. We present a visual map of the relationship between these two conceptualisations, drawn from our analysis of the literature. We conclude by discussing the implications of the findings and recommend future directions for practice, research and policy to support affected families.