Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities

Abstract

BackgroundVerbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB) is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism.MethodsThe goals of this secondary analysis of a cross-sectional study are to determine the prevalence of verbal and physical aggressive behaviours and to identify associated factors among older adults in long-term care facilities in the Quebec City area (n = 2 332).ResultsThe same percentage of older adults displayed physical aggressive behaviour (21.2%) or verbal aggressive behaviour (21.5%), whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical) were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia.ConclusionCognitive impairment severity is the most significant predisposing factor for aggressive behaviour among older adults in long-term care facilities in the Quebec City area. Physical and chemical restraints were also significantly associated with AB. Based on these results, we suggest that caregivers should provide care to older adults with AB using approaches such as the progressively lowered stress threshold model and reactance theory which stress the importance of paying attention to the severity of cognitive impairment and avoiding the use of chemical or physical restraints.

Assessment of the Relationship between Violence and Burnout among Physicians Working in Emergency Departments, Turkey

“…The consequences are emotions like anger or anxiety extending to psychological disorders like burnout. [12,[27][28][29][30][31] Gascón et al [30] have found that there is a statistically significant association between verbal violence and anxiety and symptoms of PostTraumatic Stress Syndrome. In their report, both physical and non-physical violence has had an identical negative impact in terms of burnout, exhaustion and conflicts of values in health care workers, which are similar to our study.…”

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

“…Three other studies used the Cohen-Mansfield Agitation Inventory (CMAI) and also described verbal and physical aggression [19][20][21]. The other quantitative studies used various instruments with varying information on their development.…”

“…The types of verbal aggression encompass shouting angrily, mild insults, threats of violence [17][18][19][20][21][22], verbal aggressiveness and agitation [23], as well as swearing, insulting, threatening, or verbal sexual harassment [24]. The types of physical aggression were swings and misses, grabbing at clothes, causing bruises and welts [22], striking, kicking, pulling hair, spitting, and throwing things [17,18,22,[24][25][26].…”

Agitated behavior in persons with dementia: The relationship between type of behavior, its frequency, and its disruptiveness

“…Agitation in persons with dementia is manifested in a wide variety of verbal and physical behaviors that deviate from social norms, including irrelevant vocalizations, screaming, cursing, restlessness, wandering, strange movements, and handling things inappropriately (De Johnge & Kat, 1996;Schreiner, 2000;Cohen-Mansfield et al, 1995). Such disruptive behaviors often indicate discomfort in the person with dementia, and are a major source of stress, disquiet, and occasionally embarrassment for caregivers and loved ones and can take a significant toll over time (Voyer et al, 2005).…”