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Abstract Details

Prevalence, Consequences and Correlates of Aggression Towards Caregivers in Parkinson’s Disease and Related Disorders: A Mixed Methods Approach
Movement Disorders
P4 - Poster Session 4 (8:00 AM-9:00 AM)
5-004

To describe the prevalence, potential risk factors, and consequences of aggression towards caregivers among individuals with Parkinson’s disease and related disorders (PDRD).
Aggression is a common manifestation of behavioral disturbances seen in neurodegenerative illness with emerging literature suggesting high prevalence among people living with PDRD.
This is a convergent, mixed methods study of 291 PDRD patient-caregiver dyads from a clinical trial of outpatient palliative care integrated into routine neurologic care. The primary outcome for quantitative analysis was caregiver-reported aggression. Spearman partial correlations of demographics, measures of disease, and dyad characteristics were used to identify associated variables, adjusting for age, sex, treatment group, and diagnosis. We conducted semi-structured interviews with 14 caregivers who reported aggression during the study, exploring antecedents and consequences of behaviors through thematic analysis, guided by the Antecedent-Behavior-Consequence model. Merging of data used a unidirectional, exploratory approach whereby qualitative themes were framed and enhanced by quantitative findings for final interpretation.
Sixty-six (22.3%) caregivers reported aggression at baseline with a 12-month incidence of 24.7%. Correlates of baseline aggression included patients’ grief (r=0.22, p<0.001), motor symptom severity (r=0.18, p<0.05), confusion (r=0.17, p<0.01), resistance to care (r=0.40, p<0.01), caregiver depression (r=0.16, p<0.05), and caregiver burden (r=0.34, p<0.001). We identified qualitative themes of potential risk factors (patients’ sense of loss as a reaction to disease burden; frustrations with motor symptoms; cognitive fluctuations; resistance to care related to shifting patient-caregiver roles) and consequences (detriments to caregiver mental health and caregiver burden).

Aggression in PDRD is common, multifactorial and adversely affects caregivers. Clinicians should screen for aggression recognizing this may be sensitive and require time alone with the caregiver to identify modifiable factors which contribute to aggression. This may include interventions which address patient factors (e.g., coping, behavioral changes) while prioritizing caregiver safety and wellbeing.
Authors/Disclosures
Zachary Macchi, MD (Intermountain Health)
PRESENTER 		The institution of Dr. Macchi has received research support from NIH/NIA.
No disclosure on file
Meredith Bock, MD (UCSF Center for Surgical Movement Disorders) The institution of Dr. Bock has received research support from 好色先生. The institution of Dr. Bock has received research support from Michael J Fox Foundation.
Janis M. Miyasaki, MD, MEd, FAAN (University of Alberta/Alberta Health Services) Dr. Miyasaki has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Miyasaki has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Oxford University Press. The institution of Dr. Miyasaki has received research support from PCORI. The institution of Dr. Miyasaki has received research support from Canadian Consortium on Neurodegeneration in Aging. The institution of Dr. Miyasaki has received research support from University Hospital Foundation. The institution of Dr. Miyasaki has received research support from Social Science and Health Research Council. The institution of Dr. Miyasaki has received research support from Parkinson Society Canada. The institution of Dr. Miyasaki has received research support from Parkinson Foundation. The institution of Dr. Miyasaki has received research support from Parkinson Foundation.
No disclosure on file
No disclosure on file
No disclosure on file
Stefan Sillau Stefan Sillau has nothing to disclose.
Benzi Kluger, MD, FAAN (University of Rochester) Dr. Kluger has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for International Neuropalliative Care Society. Dr. Kluger has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of Palliative Medicine. The institution of Dr. Kluger has received research support from NIH. The institution of Dr. Kluger has received research support from PCORI.