Beyond disruptive behaviors and caregiving burden: the role of family dynamics in potentially harmful behaviors by dementia informal caregivers.

OBJECTIVES: Invoking the perspective that unpleasant behaviors can be transmitted within a family through social learning, emotional mimicry, and emotional displacement, the primary study objective is to examine whether negative family exchanges induce potentially harmful behaviors (PHB) by caregivers. The secondary objective is to clarify the causal relationship between burden and (care-recipient) challenging behaviors on the one hand, and PHB on the other, in light of the lack of longitudinal evidence.

METHODS: 99 Alzheimer family caregivers participated in a 6-month 2-wave longitudinal survey. Ten items tapping psychological and physical domains were used to assess PHB. The quality of exchanges with each familial network member was measured using the social convoy questionnaire.

RESULTS: Controlling for baseline PHB in multiple regression, BPSD did not predict PHB at follow-up, but burden did. However, the effect of burden was reduced to nonsignificance after including family exchange variables. In the final model, only negative family exchanges significantly predicted PHB (f2 = 0.05), and this effect was not mediated by burden.

CONCLUSION: Negative family exchanges contribute to caregivers' PHB over and above burden, underscoring the need to address the broader family dynamics in which caregiving is embedded in dementia care.