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April 19, 2016

Violence Against Women and Dementia

Reuel S. Amdur

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"Punch Drunk Wives: for many women there is more to dementia than just getting older." That was the title of a presentation by Carleton University social work professor Roy Hanes before a meeting of SWAG (Social Workers in Aging and Gerontology) held in Ottawa on February 19.

The idea of looking at the relationship between intimate partner violence (IPV) and dementia occurred to him because of his own mother’s onset of dementia. “She suffered 12 or 13 years of beatings before she left,” he said.

“When I began to look into the subject, I found almost no literature on the subject.  Everything was on sports.”  Beginning in the 1920’s studies on dementia in former boxers began to appear.  Now there is attention to head trauma in football and hockey.  “All the top stories on head injury on the web are about athletes.”  When he scanned files from the New York Times, Globe and Mail, and Ottawa Citizen, he found the same thing.  Athletes.

We know, he explained, that women who have suffered physical abuse are four times more likely to develop Alzheimer’s.  He wants to focus on chronic traumatic encephalopathy (CTE), which like Alzheimer’s involves progressive degeneration of brain tissue.  Is there, he wants to know, a connection between IPV and CTE?  People present at the session thought that female athletes might also be a group that might be studied. 

In studying the question of the relationship between IPV and CTE, we face some large barriers.  To begin, there is secrecy around IPV.  “Don’t ask, don’t tell.”  “Professionals rarely ask about spousal abuse and rarely make a connection between earlier violence and present-day health status.”  And when the health professional knows about earlier violence, he does not ordinarily make the connection with depression and dementia later in life.  As well, if, after a period of violence and separation, a couple reconciles, the professional may well not go into past events.” 

He noted that CTE is not well understood.  We know little about its prevalence and causes and its diagnosis can only be definitively established by autopsy.  There is no cure.  Thus, once CTE is suspected, it is too late for treatment.  The only possible point of intervention is in prevention.

Hanes noted that symptoms of CET only ordinarily appear eight to ten years after the trauma.  Symptoms include cognitive impairment, impulsivity, depression, apathy, short-term memory loss, difficulty in executive functions (planning and carrying out tasks), emotional instability, and substance abuse.

He was raising the subject with social workers because he sees them as key to identifying the problem in their clientèle.  And organizations in which they work may be in a position to conduct longitudinal studies.  As well, the whole area of IPV is one that should more regularly be touched upon in case history interviews.

Whether female dementia sufferers of abuse end up with Alzheimer’s or CTE, we are left nevertheless with the question of how to intervene.  Since there is no cure for either, “We need,” he argued, “to look to prevention.” 

Prevention involves alerting women to the danger if they stay in an abusive relationship.  Helping women to decide to leave is often not a simple matter, especially since the dangers considered here are often in the distant future.  Hanes points to two other areas of intervention—greater public awareness and intervention with male abusers.

Greater public awareness has helped in curtailing smoking, but it continues to be difficult for individual smokers to quit.  The greater awareness of the dangers of violence might encourage more women to stop relationships in which violence occurs early in such relationships.  However, it might be more difficult to convince men not to abuse, as they do not face the prospect of the future dementia themselves.  Yet, for men wanting to change, this might be an additional motivating factor.

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