Abstract
Context
Little research has been conducted on aggression directed at staff by nursing home residents.
Objective
To estimate the prevalence of resident-to-staff 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.
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Acknowledgements
(1) Contributors: The authors would like to thank the team of research assistants for their work on the project and the nursing staff who participated in this study.
(2) Funders: The design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript was supported by the following grants: National Institute on Aging, NIA 2RO1 AG014299-06A2, Resident to Resident Elder Mistreatment (RREM) in Long Term Care Facilities; National Institute of Justice, NIJ FYO 42USC3721, Documentation of Resident to Resident Mistreatment in Residential Care Facilities; the New York State Department of Health (NYSDOH) Dementia Grant Program contract no. C-022657, Staff Training in Resident-to-Resident Elder Mistreatment, and by The Harry & Jeanette Weinberg Center for Elder Abuse Prevention. The views expressed in this paper are those of the authors and do not necessarily represent those of the National Institute of Justice.
(3) Prior Presentations: This work, presented at the Annual Meetings of the American Geriatrics Society in Seattle, May, 2012, won the outstanding health services research award.
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The authors declare that they do not have a conflict of interest.
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Lachs, M.S., Rosen, T., Teresi, J.A. et al. Verbal and Physical Aggression Directed at Nursing Home Staff by Residents. J GEN INTERN MED 28, 660–667 (2013). https://doi.org/10.1007/s11606-012-2284-1
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DOI: https://doi.org/10.1007/s11606-012-2284-1