Senior-to-senior aggression common in US nursing homes

Up to one in five residents involved in unpleasant, sometimes inappropriate confrontations, N.Y. study suggests.

22 nov 2014—Elderly adults who live in nursing homes may commonly deal with aggressive or inappropriate behavior from fellow residents, a new study suggests.

The study of 10 centers in New York state found that, in the space of just one month, nearly 20 percent of residents were involved in some type of incident with a fellow resident.

Most often, it was a verbal clash, with someone yelling or cursing at another resident. In other cases, the incidents involved hitting or kicking—or, in a small percentage, inappropriate touching.

"We discovered that this is a much more prevalent problem than any of us realized," said researcher Karl Pillemer, a gerontology professor at Weill Cornell Medical College in New York City.

Results of the study were presented at a recent meeting of the Gerontological Society of America. Findings from studies presented at meetings are generally considered preliminary until they've been published in a peer-reviewed journal.

Pillemer's research also zeroed in on the residents who were most likely to be involved in incidents. "Typically," Pillemer said, "they were people who were in the moderate stages of dementia, but were still physically able to get around."

That makes sense, according to Dr. Laura Mosqueda, a geriatrics specialist who was not involved in the study. Mosqueda directs the National Center on Elder Abuse at the University of Southern California, in Los Angeles.

Nursing home residents with dementia commonly become confused, and may act out aggressively—but only if they have the physical capacity to do so, explained Mosqueda.

"I think the point this study raises is, who's responsible or accountable for this behavior?" Mosqueda said. "It's not the residents. In my view, it's the owners and people running the facilities. Do they have enough staff with the appropriate training?"

Still, Mosqueda also cautioned against an alarmist interpretation of the findings.

She noted that one of the more common forms of "aggression" in this study was "unwelcome entry" into another resident's room or going through another person's possessions.

"I'm not saying that behavior is OK," Mosqueda said. But, she added, it's common for dementia patients to become confused and unintentionally wander into a room that is not theirs.

For the study, Pillemer's team randomly selected 10 nursing homes in New York state that housed more than 2,000 residents altogether. Through staff interviews, surveys of residents and direct observation, the researchers estimated that over one month, nearly 20 percent of residents were involved in at least one incident of aggressive or inappropriate behavior.

Overall, 16 percent were involved in a verbal clash, while 10.5 percent had an invasion-of-privacy issue. Almost 6 percent were involved in a physical incident, like kicking, biting or hitting; and just over 1 percent experienced a sexual incident, like inappropriate touching, according to the researchers.

Pillemer said his team did not try to distinguish between "perpetrator" and "victim."

"It's often difficult to know," he noted. "And when you're talking about people with dementia, the traditional terms of 'perpetrator' and 'victim' don't hold up anyway."

One surprise, Pillemer said, was that men and women were equally likely to be involved in these incidents. "We'd suspected that it might be more common among men, but that wasn't the case," he said.

Pillemer added that the findings highlight an issue for nursing home administrators to address. Facilities need not only enough staff members, but also adequately trained ones, he said.

"We believe that the first line of defense is appropriate staff training," Pillemer said. He added that right now, staff often feel frustrated by incidents between residents, but "relatively helpless" in preventing them.

Beyond training, Pillemer said nursing homes could look at their design, and see whether "crowding" in hallways or shared areas could be minimized. "They could also pay attention to how they assign roommates," he said. "Are there some residents who are likely to do better without a roommate?"

As for families, Pillemer and Mosqueda said awareness of the issue is key. "I'd suggest visiting often and spending time not only in your family member's room, but also the public areas," Mosqueda said. If you notice a problem, tell the staff, she advised.

Pillemer agreed, adding, "If your family member complains of being bullied or being scared of another resident, take it seriously and tell the staff."

"Remember," Pillemer noted, "the staff is probably as concerned about these issues as you are."

More information: The U.S. National Institute on Aging has advice on choosing a nursing home.