Contents

Search

aggressive behavior in the elderly

Etiology: - Alzheimer's disease is the most common comorbidity - risk factors among staff/caregiver victims include: - hurrying residents to complete ADLs - high workload - young age - higher staff anger scores - failing to understand that the behavior of the staff member must change, the demented resident's behavior will not - resident to resident aggression Epidemiology: - 25% of workplace violence occurs in a nursing home - repetitive aggressive disruptive behavior occurs regularly in 43-85% of nursing facilities - resident to resident aggression is common Clinical manifestations: - repetitive demands - verbal outbursts - sexual advances - physically aggressive acts - 75% occur during close staff-resident contact - 43% occur with dressing - 33% occur with transfers or turns - more severely demented patients may be more likely to commit physically aggressive acts without typical escalation of verbal outbursts - aggression of residents toward nursing home staff - verbal aggression is most frequent (77%) - physical aggression (54%) - sexual aggression (7%). Complications: - resident to resident aggression can have clinical, quality of life, regulatory & legal consequences Management: - behavioral management training for staff - defining aggressive behavior - identifying reasons for aggressive behaviot - enhancing communication techniques - mentoring de-escalation approaches - pharmacologic agent if behavioral management unsuccessful - risperidone has the most data to support its use [1,6]

Related

psychosis, agitation & difficult behavior in the elderly

General

aggression geriatric disorder; disease of old age; geriatric syndrome

References

  1. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  2. Burgio LD, Stevens A, Burgio KL Teaching and maintaining behavior management skills in the nursing home. Gerontologist. 2002 Aug;42(4):487-96. PMID: 12145376
  3. Gates D, Fitzwater E, Succop P. Relationships of stressors, strain, and anger to caregiver assaults. Issues Ment Health Nurs. 2003 Dec;24(8):775-93. PMID: 13129753
  4. Rosen T, Pillemer K, Lachs M. Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem. Aggress Violent Behav. 2008 Mar 1;13(2):77-87. PMID: 19750126 - Rosen T, Lachs MS, Bharucha AJ et al Resident-to-resident aggression in long-term care facilities: insights from focus groups of nursing home residents and staff. J Am Geriatr Soc. 2008 Aug;56(8):1398-408. PMID: 18637979
  5. Lachs M, Bachman R, Williams CS, O'Leary JR. Resident-to-resident elder mistreatment and police contact in nursing homes: findings from a population-based cohort. J Am Geriatr Soc. 2007 Jun;55(6):840-5. PMID: 17537083
  6. Davies SJ, Burhan AM, Kim D et al Sequential drug treatment algorithm for agitation and aggression in Alzheimer's and mixed dementia. J Psychopharmacol. 2018 May;32(5):509-523. PMID: 29338602 PMCID: PMC5944080 Free PMC article.