RESEARCH BRIEF: POTENTIAL

INTERVENTIONS FOCUSED ON PREVENTION

OF BEHAVIORAL PROBLEMS IN NURSING

HOMESBarbara Resnick, PhD, CRNP, FAAN, FAANP

“Potentially modifiable resident characteristicsthat are associated with physical or verbal aggressionamong nursing home residents with dementia.”1

Management of aggressive behavior among nursinghome residents is a major challenge for caregiversand has an impact on quality of life of all residents.Approximately 7% of residents engage in physicallyaggressive behaviors each week.2 Attempts may bemade to figure out the underlying cause of the resi-dents’ aggressive behavior and, in some cases, maylabel the resident who engages in such behavior asunpleasant, angry, or nasty person. A recently pub-lished cross-sectional study1 reported some interest-ing relationships between aggressive behavior andphysical problems that may help guide the develop-ment of interventions to decrease the aggressionnoted in nursing homes.

The study included data from nursing home resi-dents in 5 states who had at least 1 annual minimumdata set (MDS) assessment completed during 2002.Case subjects were defined as nursing home residents�60 years with dementia who were reported to havebeen physically aggressive in the week before theirassessment. Control subjects were all other residents�60 years and older with dementia. The main out-come measures included being physically aggressiveduring the previous week as defined by the MDS,“others were hit, shoved, scratched, sexually abused”;or being verbally abusive, defined as “others werethreatened, screamed at, cursed at.”

Of 103,344 residents met study criteria, of whom7120 (6.9%) had been physically aggressive in theweek before their annual MDS assessment. After ad-justment for potential confounders, including age,sex, severity of cognitive impairment, and depen-dence in activities of daily living, physical aggressionwas associated with depressive symptoms (adjusted

odds ratio [AOR] 3.3; 99% confidence interval [CI]3.0–3.6), delusions (AOR 2.0; 99% CI 1.7–2.4), hallu-cinations (AOR 1.4; 99% CI 1.1–1.8), and constipation(AOR 1.3; 99% CI 1.2–1.5). Urinary tract infections,respiratory tract infections, fevers, reported pain, andparticipation in recreational activities were not sig-nificantly associated with physical aggression in mul-tivariate analyses (P � .01 for all). Except for consti-pation, the same problems were noted to be relatedto verbal aggression. Depression had the strongestrelationship to aggressive behavior, followed by de-lusions, hallucinations, and constipation (not relatedto verbal aggression).

The underlying purpose of this study was to iden-tify modifiable problems and thereby prevent aggres-sive behavior in nursing home residents. Unfortu-nately, although the findings are interesting, theyleave us in a bit of a catch-22. The problems identifiedthat seem to be related to aggression are also prob-lems that are challenging to treat and often requirecombined behavioral and pharmacological interven-tions. That being said, ongoing research is clearlyneeded in this area to move us beyond crisis manage-ment in the nursing home setting and to develop andtest interventions to prevent aggression among nurs-ing residents.

References

1. Leonard R, Tinetti ME, Allore HG, et al. Potentiallymodifiable resident characteristics that are associatedwith physical or verbal aggression among nursing homeresidents with dementia. Arch Intern Med 2006;166:1295-300.

2. Centers for Medicare & Medicaid Services Web site.Available: www.hcfa.gov. Cited July 2006.

BARBARA RESNICK, PhD, CRNP, FAAN, FAANP, is a

professor at the University of Maryland School of Nursing,

a nurse practitioner at Roland Park Place in Baltimore,

and editor of Geriatric Nursing.

0197-4572/06/$ - see front matter

© 2006 Mosby, Inc. All rights reserved.

doi:10.1016/j.gerinurse.2006.08.009

Geriatric Nursing, Volume 27, Number 5282