Ground-breaking studies find abuse among nursing homes residents

When people hear about elder abuse in nursing homes, they usually think of staff members victimizing residents. However, research by Professor Karl Pillemer suggests that a more prevalent and serious problem may be aggression and violence that occurs between residents themselves.

Such “resident-to-resident mistreatment” can have serious consequences for both aggressors and victims. However, the issue has received little attention from researchers to date and few proven solutions exist to prevent resident altercations.

Pillemer, Director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology, has co-authored two articles in Aggression and Violent Behavior and the Journal of the American Geriatrics Society on the subject with Weill Cornell Medical College collaborators Mark S. Lachs and Tony Rosen. Both find that verbal and physical aggression between residents is common and problematic and that more research is necessary to identify risk factors and preventative measures.

“Anyone who spends much time in a nursing home will observe arguments, threats, and shouting matches among residents, as well as behaviors like pushing, shoving, and hitting,” Pillemer said.

“Given that nursing homes are environments where people live close together and many residents have lowered inhibitions because of dementia, such incidents are not surprising,” he said. “Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem.”

The joint research project found 35 different types of physical and verbal abuse between residents at a large urban nursing home Screaming was the most common form of aggression, followed by physical violence such as pushing and punching or fighting. In related work, the authors found that 2.4 percent of residents reported personally experiencing physical aggression from another resident and 7.3 percent reported experiencing verbal aggression over just a two-week period.

Most respondents rated the events as moderately or extremely disruptive to daily activities. In another study, 12 nurse-observers identified 30 episodes of resident-to-resident aggression on a just a single eight-hour shift, 17 of which were physical.

Research also indicates that residents who are victims of aggression are more likely to be male, have behavioral problems like wandering, and be cognitively impaired. However, they tend to be more physically independent.

While such incidents are difficult to prevent, these types of studies will help nursing home staff manage aggression among patients, Pillemer said.

Dr. Lachs, co-Chief of Geriatrics at Weill, added: “At present, staff have few solutions available to them and typical interventions in the nursing home may have negative consequences for aggressive residents, including the use of psychotropic medications or isolation of the resident. We hope our work will help inspire a vigorous search for programs that work to prevent aggression and violence among residents in long-term care.”