A Well-Known Problem

A recent study revealed that resident-on-resident attacks are a problem in nursing homes all over the world.  They are embedded in shared cultural expectations of institutional care and the stressors of dementia itself.

Deaths caused by nursing home residents caused by resident to resident altercations remain rare throughout nations because they go underreported.

“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,” the study authors wrote.

Nursing home homicides are often rationalized as many believe that elderly nursing home residents are not likely to cause violence as they have lived longer therefore having stronger coping skills and management of stress. A variety of key factors increase the chances of such violence happening in nursing homes, one being a dementia diagnosis. Researchers also found that regardless of geography, intentional or unintentional violence, this violence is typically caused by males with cognitive challenges or mental health disorders.

An American researcher has also linked these attacks to an invasion of personal space, unwanted entry into bedrooms and bathrooms, conflicts among roommates, and personal belongings like food items being taken away.

The Australian researchers searched various sources— search engines, websites, and literary reviews between January and December 2023 for reports on resident-to-resident deaths across the US, Australia, Canada, China, France, New Zealand, Singapore, and the UK. One study specifically studied newly admitted male long-term care residents between the ages of 75 and 84 years old.

Using the Aggressive Behavior Risk Assessment Tool confirmed that certain factors such as Alzheimer’s, dementia, history of aggressive behavior, anxiety, and confusion could all be factors to predict violence. Seventeen studies showed that residents with dementia showed aggressive behavior leading up to a homicide.
In the coming years, more adults will be seeking long-term care facilities. To assist in this influx of adults, processes should be in place to decrease and recognize 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.”

The review found more than 40 recommendations that providers and employees at long-term care facilities can use to enhance resident safety.
There are three categories:
● Education and research: this includes better training and a stronger sense of understanding of how to care for individuals with dementia, paranoia, aggression, and other ailments.
● Facility management and staff: suggestions included lowering staff-to-resident ratios and assessing residents for mental health disorders, dementia, and symptoms of overprescribing.
● Government: lawmakers should increase regulation around high-risk residents, audit facilities after an incident, and regularly and consistently investigate unnatural deaths.