Alcohol Use and Abusive or Neglectful Behaviors Among Family Caregivers of Patients With Dementia

Abstract

IMPORTANCE The increasing prevalence of dementia presents challenges for family caregivers. Understanding how alcohol use among caregivers relates to abusive and neglectful behaviors (ANBs) toward care recipients with dementia may inform interventions to improve the well-being of both. OBJECTIVE To explore alcohol use patterns among family caregivers of relatives with dementia and investigate whether hazardous drinking and drinking on a given day are independently associated with increased odds of ANBs toward care recipients. DESIGN, SETTING, AND PARTICIPANTS This microlongitudinal cohort study included a baseline survey and 21 days of daily diary surveys among a convenience sample of family caregivers aged 18 years or older who coresided with and provided unpaid care to a community-dwelling relative with dementia across the US. Enrollment was from October 2019 to February 2023. EXPOSURES Hazardous drinking at baseline, identified by the Alcohol Use Disorder Identification Test–Consumption screening tool, and daily alcohol consumption recorded in daily diary surveys. MAIN OUTCOMES AND MEASURES Daily reports assessed engagement in physically aggressive, psychologically aggressive, and/or neglectful behaviors toward care recipients, categorized as binary outcomes. A generalized linear mixed model examined associations between caregivers’ baseline hazardous drinking status and daily alcohol use and odds of ANBs. RESULTS Of 453 family caregivers (394 of 451 [87.4%] female; mean [SD] age, 51.6 [14.0] years), 82 (18.1%) screened positive for hazardous drinking. Over the 21-day period, 38 (8.4%) consumed alcohol at least once and 341 (75.3%) engaged in abusive or neglectful behavior at least once. Baseline hazardous drinking was associated with higher odds of engaging in neglectful behaviors (odds ratio [OR], 2.89; 95% CI, 1.74-4.80; P < .001) and psychologically aggressive behaviors (OR, 2.32; 95% CI, 1.28-4.19; P = .006). Any alcohol use on a given day was associated with greater odds of physically aggressive (OR, 2.32; 95% CI, 1.10-4.88; P = .03) and neglectful (OR, 1.66; 95% CI, 1.31-2.10; P < .001) behaviors on the same day. No statistically significant interaction between baseline hazardous drinking and daily alcohol use was observed. CONCLUSIONS AND RELEVANCE In this microlongitudinal cohort study of family caregivers of relatives with dementia, hazardous drinking and daily alcohol consumption were significantly and independently associated with increased odds of ANBs, highlighting the need for personalized interventions that address caregiving complexities and alcohol use patterns.