Aggression among nursing home patients widespread - Yahoo! News

NEW YORK (Reuters Health) - Aggression among nursing home residents is extremely common, and often triggered by territorial issues, according to one of only a handful of studies to look at this issue.

The findings suggest that giving residents more control and choice in their daily lives, as well as not having demented and non-demented individuals share living space, might help relieve the problem, Tony Rosen of Weill Medical College at Cornell University in New York City and colleagues say.

Most research on nursing home violence has looked at resident abuse by staff or assaults on staff by residents, Rosen and his team note. But given the fact that many residents are demented or otherwise cognitively impaired, and often forced to live in close quarters, "resident-to-resident aggression may be a much more prevalent and problematic phenomenon," they write in the Journal of the American Geriatrics Society.

To investigate, Rosen and his team conducted 15 focus groups with 96 staff members of large urban nursing home, and one focus group including seven residents of the nursing home who were not cognitively impaired.
Overall, the focus group participants listed 35 types of resident-to-resident aggression, 29 triggers of such behavior, and 25 strategies staff members used to prevent or cope with aggression among residents.

The most common type of resident-to-resident aggression the participants described was screaming or yelling, while making noise and calling out were the most frequent trigger of such episodes. These episodes occurred around the clock and throughout the nursing home, but appeared to take place most frequently in the afternoon, while the dining room and residents' rooms were the most common sites for aggressive episodes.

Seventy-five percent of the focus groups cited territoriality as a source of conflict, for example fighting for a particular seat in the dining room, while 69 percent of the focus groups mentioned conflict between roommates over preferences for television volume, lighting and other factors as a trigger of aggressive episodes.

There are no proven strategies for managing this type of aggression effectively, Rosen and his colleagues say, and nursing home staff must often try to provide demented patients with a regular routine -- which may include having them sit in the same place every day -- while trying to discourage territoriality.

The territoriality exhibited by residents may stem from feelings of loss of control and choice in daily life, the researchers note. "Empowering certified nurse assistants to personalize care and to customize daily routines to suit the desires of individual residents may reduce these behaviors," they suggest.

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