Gregory Paveza

Drug Use Patterns of Persons with Alzheimer's Disease and Related Disorders Living in the Community

Objective: To describe drug use patterns by persons with Alzheimers disease, multi‐infarct dementia, and mixed Alzheimers disease and multi‐infarct dementia.

Sex differences in the psychiatric manifestations of Alzheimer's disease.

Objective: To test the null hypothesis, ie, that there are no gender differences in psychiatric problems manifest in patients with Alzheimers disease.

Physical Mistreatment in Persons with Alzheimer’s Disease

Physical mistreatment has been estimated to affect 2 million older persons each year and dramatically affects health outcomes. While researchers have attempted to examine risk factors for specific forms of abuse, many have been able to focus on only victim or perpetrator characteristics, or a limited number of psychosocial variables at any one time. Additionally, data on risk factors for subgroups such as persons with Alzheimers disease who may have heightened and/or unique risk profiles has also been limited. This paper examines risk for physical violence in caregiver/patient dyads who participated in the Aggression and Violence in Community-Based Alzheimers Families Grant. Data were collected via in-person interview and mailed survey and included demographics as well as measures of violence, physical and emotional health, and health behaviors. Logistic regression analysis indicated that caregivers providing care to elders with high levels of functional impairment or dementia symptoms, or who had alcohol problems, were more likely to use violence as a conflict resolution strategy, as were caregivers who were providing care to elders who used violence against them. By contrast, caregivers with high self-esteem were less likely to use violence as a conflict resolution strategy. Significant interaction effects were also noted.

Changes in Conflict Resolution Style over Time: The Risk for Persons with Alzheimer's Dementia

Background: Elder mistreatment is a serious issue affecting between 300,000 and 800,000 older adults. Elder mistreatment has serious consequences for older adults and can include immunological dysfunction, increased mortality and emotional difficulties such as depression, feelings of inadequacy and self-contempt. Sub-groups such as persons with Alzheimer’s disease have heightened risk for elder mistreatment, but it is not clear whether this heightened risk represents life-long patterns of abuse between persons or whether they represent a change in conflict style over time as a result of changes associated with dementia. Methods: Data analyzed in this study were collected as part of the Aggression and Violence in Community Based Alzheimer’s Study [AV-CAD] and represents patient caregiver/dyads who received care at one of five state funded medical clinics or who belonged to one of three local chapters of the Alzheimer’s Association. Data were collected via in-person interview and mailed survey, and changes in conflict resolution style (reasoning, verbal aggression and violence) pre and post dementia were measured using the Conflict Tactic Scale (CTS) and analyzed using McNemar’s Test. Results: Reasoning was used as a conflict resolution style in 91.4% of caregivers and 89.3% of elders prior to the onset of dementia and in 66.3% of caregivers and 45.3% of elders in the past year (post dementia diagnosis). Reasoning in the post dementia period was significantly related to use of reasoning in the pre dementia period for caregivers (X2=7.47, p=.0032) and approached significance for elders (X2=6.00; p=.057). Use of verbal aggression (VA) and violence (V) as a conflict resolution style post dementia was higher for both caregivers (VA: 59.3%; V: 16.8%) and elders (VA: 68.7%; V: 24%), but was not significantly related to behaviors in the pre-dementia period for caregivers (V: X2=1.55, p=.536; VA: X2=0.67, p=.528) or elders (V: X2=0.54, p=.628; VA: X2=0.43, p=.621) Conclusions: This study lends support to the idea that elder abuse in a large number of persons with Alzheimer’s disease may be in part a result of the etiology of the disease and is susceptible over time. Implications for policy, practice and future research are discussed.

The Elder Justice Bill's Impact on Research: Likely Fact or Fiction

The Elder Justice Bill (U.S. Senate Bill 333) recently reintroduced by Senators Breaux and Hatch along with a growing list of co-sponsors is the second attempt, Senate Bill 2933 introduced in the 107th Congress being the first, to put in place a national policy addressing the plight of older Americans who are abused, neglected and exploited. As with all bills that establish policy, however, the real proof will ultimately come in the appropriations bills that put money where the policy bill says funding is needed. That said, this bill includes within its provisions a number of sections which attempt to address the research issues that have for some time now loomed large in the field. The lack of on-going substantive research in the field continues to be the major problem for elder abuse. This problem has been well documented in a number of publications, the two most critical being the recent reports out of the National Academies of Science. The report of the Institute of Medicine’s Committee on the Training Needs of Health Professionals to Respond to Family Violence (IOM) (Institute of Medicine, 2002) notes that one of the difficulties in developing training programs for health professionals in elder abuse is the lack of substantive research on risk factors and forensic identifiers. Thus it becomes difficult for those charged with health professional ed-