Verbal and Physical Aggression Directed at Nursing Home Staff by Residents

Abstract

CONTEXT: Little research has been conducted on aggression directed at staff by nursing home residents. OBJECTIVE: To estimate the prevalence of resident-tostaff aggression (RSA) over a 2-week period. DESIGN: Prevalent cohort study. SETTING: Large urban nursing homes. PARTICIPANTS: Population-based sample of 1,552 residents (80 % of eligible residents) and 282 certified nursing assistants. MAIN OUTCOME MEASURES: Measures of resident characteristics and staff reports of physical, verbal, or sexual behaviors directed at staff by residents. RESULTS: The staff response rate was 89 %. Staff reported that 15.6 % of residents directed aggressive behaviors toward them (2.8 % physical, 7.5 % verbal, 0.5 % sexual, and 4.8 % both verbal and physical). The most commonly reported type was verbal (12.4 %), particularly screaming at the certified nursing assistant (9.0 % of residents). Overall, physical aggression toward staff was reported for 7.6 % of residents, the most common being hitting (3.9 % of residents). Aggressive behaviors occurred most commonly in resident rooms (77.2 %) and in the morning (84.3 %), typically during the provision of morning care. In a logistic regression model, three clinical factors were significantly associated with resident-to-staff aggression: greater disordered behavior (OR =6.48, 95 % CI: 4.55, 9.21), affective disturbance (OR=2.29, 95 % CI: 1.68, 3.13), and need for activities of daily living morning assistance (OR= 2.16, 95 % CI: 1.53, 3.05). Hispanic (as contrasted with White) residents were less likely to be identified as aggressors toward staff (OR=0.57, 95 % CI: 0.36, 0.91). CONCLUSION: Resident-to-staff aggression in nursing homes is common, particularly during morning care. A variety of demographic and clinical factors was associated with resident-to-staff aggression; this could serve as the basis for evidence-based interventions. Because RSA may negatively affect the quality of care, resident and staff safety, and staff job satisfaction and turnover, further research is needed to understand its causes and consequences and to develop interventions to mitigate its potential impact.KEY WORDS: nursing home; dementia-related behaviors; elder abuse; staff mistreatment.

Managing Resident-to-Resident Elder Mistreatment in Nursing Homes: The SEARCH Approach

“…There is also a small body of literature on the mistreatment of elderly residents by staff of nursing homes (Cohen, Halevy-Levin, Gagin, Priltuzky, & Friedman, 2010; Payne & Cikovic, 1994; Pillemer & Moore, 1989), and on aggressive behaviors experienced by family members and paid caregivers at the hands of older people with dementia (Finkel, Costa de Silva, Cohen, Miller, & Sartorius, 1997; Lachs et al, 2012). …”

“…However, there is mounting interest in R-REM, as indicated by a number of recent articles (Castle, 2012; Lachs et al, 2012; Pillemer et al, 2011; Ramirez et al, 2013; Rosen et al, 2008; Shinoda-Tagawa, Leonard, Pontikas, McDonough, Allen, & Dreyer, 2004; Teresi et al, 2013a, Teresi et al, 2013b). Such aggression has been found to be extensive (Pillemer et al, 2011; Shinoda-Tagawa et al, 2004) and can have both physical and psychological consequences for residents and staff (Cohen – Mansfield, Marx and Rosenthal, 1989; Rosen et al, 2008).…”

The work of health auxiliaries in social services and the implementation of a new approach to intervene with clients with dementia

“…A review of the literature identified five major risk factors for the health of these workers. These factors are: (1) high physical demands [16; 17], (2) client assaults that put their mental and physical health at risk [18], (3) ethical suffering linked to a gap between the prescribed organization and the actual organization of tasks [19], (4) low social support and poor decision-making latitude [20], and (5) strong emotional demands and low recognition at work [21].…”

State of the science on prevention of elder abuse and lessons learned from child abuse and domestic violence prevention: Toward a conceptual framework for research

“…Although not as common, another form of abuse in institutional settings is staff-to-resident abuse (Pillemer & Moore, 1989). Finally, the phenomenon of resident-to-staff aggression has been studied recently (Lachs et al, 2013). In that study it was found that the prevalence of staff-reported physical and verbal aggression by residents directed toward staff was high, with 15.6% of residents reported to direct aggressive behavior toward staff, 8% of which was physical.…”