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A new study reveals resident-on-resident attacks are not a problem unique to American nursing homes but more likely embedded in shared cultural expectations of institutional care and the stresses of dementia itself.
Deaths caused by a fellow nursing home resident remain rare across nations but also are underreported, added the study published Monday in Nursing Inquiry.
“Homicide involving older people is less likely to involve a post-mortem investigation as the cause for deaths is commonly thought to be related to age or a fall, rather than violence. This is often taken to mean they are absent as perpetrators of aggression or as victims, however, this is not the case,” study authors wrote.
Nursing home homicides ”are often rationalized and assumptions are made that older people have more life experience, better coping skills to manage stress or that they are not physically capable of extreme violence, therefore not likely to cause a violent death,” the group of Australian researchers found.
They pointed to several key factors that increased the chances of such violent events occurring in nursing homes, the most prominent being a dementia diagnosis. They also found that, regardless of geography, intentional or unintentional violence was typically caused by males with cognitive challenges or a mental health disorder who targeted a roommate nine to 16 years their senior.
An American researcher has previously linked resident attacks on invasion of personal space, unwanted entries into bedrooms and bathrooms, conflicts between roommates, and taking personal belongings and food items from each other. Eilon Caspi, PhD, has told McKnight’s Long-Term Care News that, left untracked, “the phenomenon remains largely invisible.”
The Australian Researchers examined various data sources — search engines, websites, literary reviews — between January and December 2023 for reports on resident-on-resident deaths across the US, Australia, Canada, China, France, New Zealand, Singapore and the UK. Twenty-six sources covered 249 reported deaths.
One report mentioned in the study specifically examined aggressive incidents involving newly admitted male long-term care residents in Canada between the ages of 75 and 84 using the 10-item Aggressive Behaviour Risk Assessment Tool. It confirmed certain factors such as Alzheimer’s or dementia, a history of aggressive behavior, anxiety and confusion may predict violence.
Further, of the data sources considered in the Nursing Inquiry review, 17 studies showed that residents with dementia had demonstrated aggressive tendencies before a homicide.
Safety recommendations
In the coming years, more adults will be seeking long-term care in facilities, the authors noted. Therefore, processes should be put in place to decrease the risk of resident-on-resident attacks.
“The frequency of such incidents is expected to rise,” they wrote. “To mitigate the risk of harm and ensure the safety of all residents and staff, it is imperative for the sector to change current approaches to institutional practices and create opportunities for contemporary and humanistic dementia care.”
Altogether, the review found more than 40 recommendations providers and others can use to enhance resident safety. They were grouped into three categories:
Education and research: Recommendations included better training and understanding how to care for individuals with dementia, paranoia, aggression and other ailments; and performing thorough assessments of residents at admission and during the duration of their nursing home stay.
Facility management and staff: Suggestions were to lower staff-to-resident ratios and assess residents for mental health disorders, dementia, and symptoms of overprescribing.
Government: The authors recommended lawmakers increase regulation around high-risk residents; audit facilities following an incident; and regularly and consistently investigate unnatural deaths.