Aggressive behaviour by people with dementia in residential care settings: a review

Abstract

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.

Aggressive Behavior of Nursing Home Residents Toward Caregivers: A Systematic Literature Review

“…However, other strategies, such as forceful holding, seclusion, fixation, and ignoring protests or recipients' requests for help [32], seem to be perceived more negatively by residents. All in all, there is a lack of evidence regarding the effectiveness of various approaches and strategies to handle aggressive behavior, and it is currently impossible to give clear recommendations as to which approaches should be adopted as best practice [4,37].…”

“…Possible causes for underreporting are a lack of competence to cope with aggressive behavior, feelings of failure, or the assumption that aggressive behavior is a common feature in the care of the elderly, especially those with psychological disturbance [1,4,9,10]. Psychological disturbances and other illnesses in the elderly may lead to aggressive behavior irrespective of situational factors.…”

“…Working in a nursing home or long-term care facility is associated with a high risk of experiencing aggression [3].Studies show that aggressive behavior is more likely to occur among older people with cognitive impairment than among those with no cognitive impairment [2,4,5] although cognitively intact residents also threaten or assault the caregivers [6]. Irrespective of whether demented residents can be held responsible for their aggressive behavior, many gerontological nurses find that physical or verbal attacks by an elderly person they are giving nursing care to is one of the most difficult, emotionally distressing, and potentially dangerous aspects of their work [7], often resulting in feelings of powerlessness, sadness, anger, and ineffectiveness [8].…”

Inhaltsvalidierung des Fragebogens «The Management of Aggression in People with Dementia Attitude Questionnaire German Version» (MAPDAQ-G)

“…In einem ersten Schritt wurden in zwei Befragungsrunden mit Experten (Polit & Beck, 2012) (Prüfer & Rexroth, 2005). Neun Items (3, 4, 6, 7b, 8, 12, 14, 15, 17) Pflegepersonen werden aber vielfach als Teil der Arbeit angesehen, die nicht zu Zwangsmassnahmen legitimieren (Pulsford & Duxbury, 2006 Der G-V-MAPDAQ müsste deshalb idealerweise auch erfassen können, was für ein Management in der jeweiligen Institution üblich ist.…”

“…Trotzdem ist es für Pflegepersonen unüblich, Aggressionen zu thematisieren. Zudem zeigt die Literatur, dass noch wenig über aggressives Verhalten von Menschen mit Demenz bekannt ist und für Pflegepersonen eher wenig Präventions-und Interventionsprogramme im Umgang mit aggressivem Verhalten angeboten werden (Hahn & Metzenthin, 2010;Pulsford & Duxbury, 2006;Skovdahl, Kihlgren & Kihlgren, 2003;Zeller, Hahn, Needham, Kok, Dussen & Halfens, 2009 (Becker & Hahn, 2011;Duxbury, 2002;Franz, Zeh, Schablon, Kuhnert & Nienhaus, 2010;Pulsford, Duxbury & Hadi, 2010).…”