According to background information provided by the authors, nursing home residents are one of the most vulnerable populations because of physical disability and cognitive impairment. The authors cite data collected by the Centers for Medicare and Medicaid Services that approximately 88,000 nursing home residents in the United States have exhibited aggressive behavior in the week prior to their assessment with the Minimum Data Set (MDS). The MDS is a comprehensive assessment that includes diagnoses and treatment/medication plans for nursing home residents that must be completed by nurses at least every three months in facilities that receive federal funding.
Tomoko Shinoda-Tagawa, M.D., M.P.H., from the Harvard School of Public Health, Boston, and colleagues assessed risk factors for violent injury to nursing home residents by other residents. The researchers used data from the Massachusetts Department of Public Health's Complaint and Incident Reporting System and from MDS assessments. They reviewed 1,132 incident reports from Massachusetts nursing home residents who were injured by another resident during the calendar year 2000. The researchers randomly selected 1,994 Massachusetts nursing home patients with no injury incident reports filed during the same time period as a control group.
Of 294 injured nursing home residents included in the analysis, 39 sustained fractures, six had dislocations, 105 had bruises or hematomas (swelling containing blood), 113 had lacerations (cuts), and 31 had reddened skin areas, according to the researchers. Injured residents were more likely (than non-injured residents) to be cognitively impaired, exhibit wandering, be verbally abusive, and have socially inappropriate behaviors. Male residents were almost twice as likely to be injured as female residents. Residents in an Alzheimer disease unit were almost three times more likely to be injured than those living in other units, whereas those who were classified as needing extensive assistance and being severely dependent were less likely to be injured.
"Our finding suggested that it is possible that some of the residents who sustained injuries may have provoked the attacks," the authors write. "Wandering was strongly associated with being injured, which suggests that some injured residents may get themselves in trouble by accidentally provoking an attack due to wandering into another residents' 'personal space.'"
The authors conclude: "Injured residents were more likely, perhaps unknowingly, to 'put themselves in harm's way,' be verbally aggressive, and be cognitively impaired. Intervention to prevent these incidents should focus on the behavior of the injured persons."
(JAMA. 2004;291:591-598. Available post-embargo at JAMA.com.)
Editor's Note: This article was supported by a research fellowship from the Uehara Memorial Foundation (Dr. Shinoda-Tagawa).
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JAMA