This week's embargoed articles may not be available until 09:00 (UK time) Thursday.

Press releases Monday 19 January 2009 to Friday 23 January 2009

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://www.bmj.com).

(1) Abuse of people with dementia by family carers is common
(2) Older people benefit from care in specialist geriatric units

(1) Abuse of people with dementia by family carers is common
(Research: Abuse of people with dementia by family carers: representative cross sectional survey)
http://www.bmj.com/cgi/doi/10.1136/bmj.b155

A third of family carers report significant abusive behaviour towards people with dementia, and half report some abusive behaviour, according to a study published on bmj.com today.

People with dementia are particularly vulnerable to abuse, which can be psychological, financial, sexual or by neglect.

The UK government is currently consulting about a revision of the policy for safeguarding vulnerable adults, but this review is entirely focused on preventing abuse by paid carers, suggesting that abuse is confined to the formal care system.

However, previous studies have shown that many family carers for people with dementia report acting abusively, and professionals are reluctant to ask about elder abuse.

So, in the first study of its kind, Claudia Cooper and colleagues set out to determine the prevalence of abuse by family carers of people with dementia.

They interviewed 220 family carers of people with dementia who were living at home and who were referred to Community Mental Health Teams in London and Essex. They defined a family carer as providing care for four or more hours/week.

Background data, such as age, sex, ethnicity and qualifications were recorded, together with details of the relationship to the care recipient, living arrangements, and whether the carer worked.

A recognised scoring scale was used to assess levels of psychological and physical abuse towards the care recipient. A score of two or more on one interview question denoted significant abuse.

One hundred and fifteen (52.3%) carers reported some abusive behaviour and 74 (33.6%) reported significant levels of abuse. Verbal abuse was most commonly reported. Only three carers (1.4%) reported that actual physical abuse sometimes occurred.

This was the first representative survey to ask family carers about abusive acts, say the authors. It suggests that any policy for safeguarding vulnerable adults must consider strategies directed towards families who provide the majority of care for older people, rather than exclusively at formal carers.

The findings also highlight the need to consider elder abuse as a spectrum of behaviours rather than an "all or nothing" phenomenon, they add. This could help professionals to feel more able to ask about it and offer appropriate assistance, they conclude.

Contact:
Claudia Cooper via Ruth Metcalfe, Media Relations Manager, UCL Development & Corporate Communications Office, London, UK
Email: r.metcalfe@ucl.ac.uk

Older people who are cared for in specialist geriatric units have a better chance of returning home after discharge than those cared for in conventional hospital units, finds a study published on bmj.com today.

They are also more likely to remain mobile and be able to carry out usual daily activities, such as dressing, eating or bathing.

Researchers in Madrid reviewed 11 studies that compared care provided in acute geriatric units (AGUs) run by specialist elderly care teams with conventional hospital units.

Patients in these studies were aged 65 years and over and had acute medical problems, such as pneumonia, heart failure, urinary tract infections or chronic obstructive pulmonary disease, which did not require treatment in other specialised units.

The majority of patients were followed for three months after discharge from hospital.

They found that AGU care reduced functional decline (ability to carry out usual daily activities) at discharge and increased the probability of returning home to live at discharge and remaining at home three months after leaving hospital.

These benefits were not associated with increased fatalities or costs of hospital care.

The authors suggest that the effectiveness of AGU care may be down to comprehensive geriatric assessment and care by specialised multidisciplinary teams and a focus on early discharge planning.

They also suggest that more studies are needed to evaluate whether these benefits are maintained in the long term.

Contact:
Dr Leocadio Rodriguez-Maņas, Chief of Geriatric Medicine Departament, Getafe Universitary Hospital, Madrid, Spain
Email: lrodriguez.hugf@salud.madrid.org

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