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the long view

In private conversations, Donald Weaver’s dementia patients and their family members often open up about the violence they face at home.

The stories are numerous, yet similar – patients wonder whether their dementia is the result of head injuries inflicted years earlier by an abusive spouse, caregivers worry that agitated patients may act out and harm others and family members voice concerns that overburdened primary caregivers might unleash their frustrations on patients.

As a researcher, University of Toronto professor and practising neurologist, Weaver works in his clinic only one day a week. But even in his limited practice, he encounters these kinds of stories multiple times a month.

“If I didn’t ask the questions, I wouldn’t be told,” he says, explaining these cases are likely just the tip of the iceberg.

Weaver, the research director of the Krembil Brain Institute at Toronto’s University Health Network, believes it’s time to bring the intertwined issues of dementia and domestic violence out into the light. In an essay published by the independent news and opinions website The Conversation last month, Weaver argued that the overlap between dementia and domestic violence has been ignored for too long, and is in need of proper scientific scrutiny.

Weaver spoke with The Globe about how to tackle three common scenarios:

The situation: My ex-husband used to hit me often. Is this why I have dementia?

“We as a society are constantly wringing our hands about hockey players and football players getting dementia from head trauma, but [domestic violence] is a source of head trauma which is real, which is out there, which is painfully common,” Weaver says.

Since there is no cure for Alzheimer’s disease and related dementias, he says, it’s important to focus on minimizing risk factors. He believes domestic violence is almost certainly one of them, but because its impact on dementia is so ill-studied, researchers have yet to demonstrate this. For now, clinicians like himself can do little more than tell inquiring patients and family members that repeated head trauma may have an effect.

Thus, he says, there is a serious need for researchers to examine the role of domestic violence in developing dementia. Depending on the study, he says, data suggest anywhere between 15 and 17 per cent of women experience domestic violence. If researchers can establish that this violence does, indeed, contribute to dementia, doctors can then inform patients and family members.

Domestic violence has many negative consequences. When doctors can add dementia to the list, it’ll be even more reason for victims and family members to find a way out, he says.

The situation: My partner can get suspicious and hostile. I’m worried he will hurt someone.

Because dementia can trigger violent mood swings and outbursts, caregivers often raise concerns with Weaver that their loved ones may harm others.

While he emphasizes he does not know of any cases where an individual with dementia has committed gun violence, he advises caregivers to remove any firearms in their homes if they express worry about them. Similarly, he suggests, caregivers may need to hide car keys or get rid of vehicles if they believe a patient with dementia is prone to road rage.

“If you’ve thought about it, it’s a risk,” he says.

To help address aggressive and hostile behaviour, Weaver suggests having a doctor review the patient’s medication. He says polypharmacy, or having patients take multiple medications, is a problem among the elderly population; many drugs can have side effects that can add to a patient’s confusion or behavioural issues. “Some actually do better on fewer meds,” he says.

The situation: My mom isn’t dealing well with my dad’s dementia. She has hit him in moments of frustration.

Physicians don’t normally ask about whether patients are being abused at home, but Weaver suggests perhaps they should.

“[Patients and family members] want to talk about it, but they’re reluctant to do so, so you have to give them the opportunity,” he says, adding that doctors also need to look out for signs, such as bruises, broken bones and whether patients are receiving adequate nutrition.

He emphasizes doctors aren’t there to punish caregivers. Instead, he says, treating an individual with dementia often also means treating the whole family.

Too often, he says, families try to provide care on their own, which can be exhausting. Involving additional helpers and seeking respite care is extremely important. For stressed and frustrated primary caregivers, it is necessary “just to get them out of the situation for a while,” Weaver says.

Families also need to consider whether a patient should be placed in a residential or long-term care facility – a decision that Weaver acknowledges can be hard on everyone.

“By no means am I saying we should be rushing to it, but it’s something that should be considered,” he says.

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