Factors associated with resident‐to‐resident elder mistreatment in nursing homes

Abstract

Background: Resident-to-resident elder mistreatment (RREM) in nursing homes has serious physical and psychological consequences, but factors related to RREM occurrence remain unclear. This study identifies individual and environmental characteristics associated with involvement in RREM episodes. Methods:The design was an observational study carried out in five urban and five suburban New York state nursing homes randomly selected on the basis of size and location. The sample consisted of 2011 residents in 10 facilities; 83% of facilities and 84% of eligible residents participated. RREM and potential correlates were identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports. Results: A multivariate analysis controlling for relevant covariates found that individuals involved in RREM incidents exhibit milder dementia, show behavioral symptoms, and are less functionally impaired. Although special care units (SCU) for dementia have benefits for residents, one potential hazard for SCU residents is elevated risk for RREM. Conclusions: Interventions to prevent and intervene in RREM incidents are greatly needed. The correlates identified in this research point to the need for targeted interventions, specifically for residents with milder impairment and with behavioral symptoms and individuals in SCUs.

Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living

“…Other research has also found higher prevalence estimates of RRA among residents in memory care units. An earlier retrospective case record study has shown that the incidence of aggressive behavior per resident per year was almost 3 times as likely among residents in memory care units than among residents in the rest of the facility . A major reason for this higher prevalence is that individuals with dementia and behavior problems resulting from it are congregated closely.…”

“…This finding aligns with findings from a prior nursing home study using a nearly identical methodological approach, with rates of 29.0% in dementia care units vs 18.5% in nondementia care units . Potentially associated with this finding is that a larger proportion of residents (39.7%) resided in memory care units in our assisted living facility sample as contrasted with 16.3% in the nursing home sample …”

“…5,21 Potentially associated with this finding is that a larger proportion of residents (39.7%) resided in memory care units in our assisted living facility sample as contrasted with 16.3% in the nursing home sample. 5,21 Other research has also found higher prevalence estimates of RRA among residents in memory care units. An earlier retrospective case record study has shown that the incidence of aggressive behavior per resident per year was almost 3 times as likely among residents in memory care units than among residents in the rest of the facility.…”

A systematic review of specialty dementia care units in long‐term care settings

“…In some cases, DSCUs were associated with better resident outcomes and quality of care (e.g., decreased use of feeding tubes, antipsychotic medications, and physical restraints; fewer hospitalizations and pressure ulcers) 82–85 . Other studies reported less favorable outcomes among residents in DSCUs, including lower levels of social connectedness 86 and higher risk for elder‐to‐elder mistreatment, 87 deficiency citations, 88 infections, 89 and antipsychotic use 90,91 …”

“…In some cases, DSCUs were associated with better resident outcomes and quality of care (e.g., decreased use of feeding tubes, antipsychotic medications, and physical restraints; fewer hospitalizations and pressure ulcers). [82][83][84][85] Other studies reported less favorable outcomes among residents in DSCUs, including lower levels of social connectedness 86 and higher risk for elder-to-elder mistreatment, 87 deficiency citations, 88 infections, 89 and antipsychotic use. 90,91 Results from a pilot study using combinations of social network analysis methods demonstrated that staff-to-resident interactions T A B L E 3 Summary of reviewed descriptive study articles in the United States (N = 13).…”