A Study on Aggressive Behavior Among Nursing Home Residents with Cognitive Impairment

  • Published : 2004.12.01

Abstract

Purpose. With a sample of cognitively impaired nursing home residents and nursing staff, the following were examined 1) the proportion and nature of aggressive behavior, 2) the frequency and types of aggressive behavior, 3) the difference between the residents who demonstrate aggressive behavior and those who do not demonstrate aggressive behavior (age, mental status, functional status, and pain, length of nursing home stay), and 4) nursing staff responses to aggressive behavior by residents. Methods. A cross-sectional descriptive study design was used. Data were collected from cognitively impaired nursing home residents (N=205) and nursing staff (N=60) at two nursing homes using Ryden Aggression Scale I and II, Mini-Mental State Exam, Modified Barthel Index, Verbal Descriptor Scale, and aggressive behavior management questionnaire. Data were analyzed using descriptive statistics including t-test. Results. About $62.9\%$ residents were found to be aggressive and $38.5\%$ were both physically and verbally aggressive. Pushing, making threatening gestures, hitting, slapping, cursing/obscene/vulgar languages, making verbal threats were occurred frequently. Aggressive residents were significantly older, had more cognitive impairment, had more pain, and stayed longer in the nursing home when compared with non-aggressive residents. Considerable proportion of nursing staff responded to aggressive behaviors inadequately. Conclusion. Aggressive behavior among cognitively impaired nursing home residents is prevalent thus needs to be prevented and reduced. Along with environmental modification, educational programs for nursing staff and family caregivers need to be developed and implemented so that they can have extensive knowledge and skills to manage aggressive behaviors.

Keywords

References

  1. Astrom, S., & Umea, U. (2000). Incidence of violence towards staff caring for the elderly. Scand J Caring Sci, 16, 66-72 https://doi.org/10.1046/j.1471-6712.2002.00052.x
  2. Beck, C., Frant, L., Chumbler, N., O'Sullivan, P., Vogelpohl, V., Rasin, Y, Walls, R., & Baldwin, B. (1998). Correlates of disruptive behavior in severely cognitively impaired nursing home residents. Gerontologist, 38 (2), 189-198
  3. Bridges-Parlet, S., Knopman, D., & Thompson, T. (1994). A descriptive study of physically aggressive behavior in dementia by direct observation. J Am Geriatr Soc, 42, 192-197
  4. Cohen-Mansfield, J., Billing, N., Lipson, S., Rosenthal, A.S., & Pawlson, L.G. (1990). Medical correlates of agitation in nursing home residents. Gerontology, 36, 150-158 https://doi.org/10.1159/000213191
  5. Cohen-Mensfield, J., & Werner, P. (1998). Predictors of aggressive behaviors: A longitudinal study in senior day care centers. J Gerontol: Psych Sci, 53B (5), 300-310
  6. Eastly, R., & Wilcock, G.K. (1997). Prevalence and correlates of aggressive behaviors occurring in patients with Alzheimer's disease. Int J Geriatr Psychiatry, 12(4), 484-487
  7. Feldt K., & Ryden, M.B. (1992). Aggressive behavior: Educating nursing assistants. J Gerontol Nurs, 18, 3-12
  8. Feldt. K.S. (1996). Treatment of pain in cognitively impaired versus cognitively intact post hip fractured elders. Diss Abstr Int, 57-09B, 5574
  9. Feldt K.S. Warne, M. A., & Ryden, M.B. (1998). Examining pain in aggressive cognitively impaired older adults. J Gerontol Nurs, 24(11), 14-22
  10. Folstein, M. F., Folstein, S.E., & Mchugh, P.R. (1975). 'Mini-mental State'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12, 189-198 https://doi.org/10.1016/0022-3956(75)90026-6
  11. Fitzwater, E., & Gates, M. (2002). Testing intervention to reduce violence in nursing homes: A pilot study. Geriatr Nurs, 23(1), 18-23
  12. Fricke, J., & Unsworth, C.A. (1997). Inter-rater reliaibility of the original and Modified Barthel Index, and a comparison with the Functional Independence Measure. Aust Occup Ther J, 44(1), 22-29
  13. Gates, D., Fitzwaer, E., & Deets, C. (2003). Development of instrument to assess: Assaultive behavior in nursing homes. J Gerontol Nurs, 29(8), 37-45
  14. Herr, K.A., & Mobily, P.R. (1993). Comparison of selected pain assessment tools for use with the elderly. Appl Nurs Res, 6, 39-4 https://doi.org/10.1016/S0897-1897(05)80041-2
  15. Hoeffer, B., Rader, J., McKenzie, D., Lavelle, M., & Stewart, B. (1997). Reducing aggression during bathing cognitively impaired nursing home residents. J Gerontol Nurs, 23(5), 16-23
  16. Kolanowski, A.M. (1995). Disturbing behaviors in demented elders: A concept synthesis. Arch Psych Nurs, 9(4), 188-194
  17. Kolanoski, A.M., & Garr, M. (1999). The relation of premorbid factors to aggressive physical behavior in dementia. J Neurosci Nurs, 31(5), 278-84
  18. Marks, M.S., Cohen-Mensfield, J., & Werner, P. (1990). A profile on the aggressive nursing home residents. Behavior, Health, and Aging, 1(1), 65-73
  19. Miller, M.F. (1996). Nursing staff responses to physically aggressive behavior in cognitively impaired institutionalized elderly: A qualitative study. Unpublished doctoral dissertation, University of Miami
  20. Patel, V., & Hope, P.A. (1992). Aggressive behavior in elderly psychiatric inpatients. Acta Psych Scan, 85, 131-135 https://doi.org/10.1111/j.1600-0447.1992.tb01457.x
  21. Oh, J. (1998). A study on the aggressive behavior of the demented elderly in a nursing home. J Korean Comm Health Nurs Acad Soc, 12(2), 172-184
  22. Oh, J. (2000). The experience of nursing staff on the demented patient's aggressive behavior. J Korean Acad Nurs, 30(2), 293-305
  23. Olson, J. (2000). Problem behavior or pain? Contemp Longterm Care, 23(1), 31
  24. Rodney, V. (2000). Nurse stress associated with aggression in people with dementia: Its relationship to hardness, cognitive appraisal and coping. J Adv Nurs, 31(1),172-180
  25. Ryden, M.B. (1988). Aggressive behavior in persons with dementia who live in the community.: Alzheimer Dis Assoc Disord: An Int J, 2, 342-355
  26. Ryden, M.B., Bossenmaier, M., & McLachlan, C. (1991). Aggressive behavior in cognitively impaired nursing home residents. Res Nurs Health, 14, 87-95 https://doi.org/10.1002/nur.4770140203
  27. Ryden, M.B. (1992). Alternative to restraints and psychotropics in the care of aggressive cognitively impaired elderly persons. In Buckwalter, K.C. (ed.), Geriatric mental health nursing: Current and future challenges. pp 84-93. Thorofare, NJ:Slack
  28. Ryden, M.B., & Feldt, K.S. (1992). Goal-directed care: Caring for aggressive nursing home residents with dementia. J Gerontol nurs, 18(11), 35-41
  29. Schreiner, A.S., Yamamoto, E., & Shitonani, H. (2000). Agitated behavior in elderly nursing home residents with dementia in Japan.J Geronto, 55B(3), 180-186
  30. Soreff, S., & Siddle, D. (2004). Understanding and dealing with resident's aggression. Nurs Homes, 53(3), 58-60
  31. Souriel, R., McCusker, J., Cole, M., & Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: Prevalence, disruptiveness, and staff burden. Int Psychogeriatr, 13(2), 183-97
  32. Talerico, K.A., Evans, L.K, & Srumpf, N.E. (2002). Mental health correlates of aggression in nursing home residents with dementia. Gerontologist, 42(2),169-177
  33. Tombaugh, T., & McIntyre, N.J. (1992). The Mini-mental State Examination: A comprehensive review. J Am geriatr Soc, 40, 922-935
  34. Winger, J., Schirm, V., & Stewart, D. (1987). Aggressive behavior in long term care. J Psychosicial Nurs, 25(4), 28-33