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Dementia Patients at Risk of Nursing Home Violence

And the assailants are often other residents

TUESDAY, Feb. 3, 2004 (HealthDayNews) -- Nursing home residents run the risk of abuse and injury by other residents.

And the typical victims are men who may actually provoke the incidents, whether they know it or not, because they suffer from some form of dementia.

So says a new study in the Feb. 4 Journal of the American Medical Association. It was co-authored by Paul I. Dreyer, associate commissioner for the Center for Quality Assurance and Control at the Massachusetts Department of Public Health.

"Everyone's focus has been on staff-to-resident abuse rather than resident-to-resident incidents," Dreyer says.

Dreyer and his team looked at 1,132 injury reports from Massachusetts nursing home residents injured by other residents during 2000. Then the team randomly selected 1,994 nursing home patients with no injury incident reports filed during the same time period to serve as a control group.

"Of those 1,132 [incident reports], the study characterized 294 as showing objective evidence of harm," Dreyer says. "The others showed no physical evidence of harm, such as a bruise. In those where there was physical evidence, there were 39 fractures, six dislocations, 105 bruises or hematomas, and 113 lacerations." There were also 31 cases of "reddened areas."

Then the team looked at other factors, such as the profile of the victim and assailant and the setting of the incident.

"The surprise of the study was that the people who were at risk for abuse were actually in better shape physically than the control residents," Dreyer says. "We had this implicit hypothesis or worry that the victims of abuse were the 100-year-old ladies who weigh 80 pounds. That is precisely what we didn't find."

"The typical victim is male, is relatively independent in activities of daily living, compared to the randomly selected control residents, and is much more likely to wander and to be cognitively impaired," Dreyer says.

Male residents were nearly twice as likely to be injured as females, and those in an Alzheimer's disease unit were nearly three times as likely to get hurt as those in other units. Those classified as in need of lots of assistance and being severely dependent were less likely to be injured, the study found.

While many incidents appeared to be unprovoked, some residents may have brought on the attack, perhaps unintentionally, by invading another resident's personal space or eating from someone else's plate, Dreyer's team found.

Only half the incident reports included information on locations. In those cases, the incidents often occurred in residents' rooms, and sometimes in hallways and dining rooms.

While the new study looked just at Massachusetts, Dreyer suspects the same problems would be found in nursing homes in other states.

On Tuesday, the Massachusetts Department of Public Health said it will issue new requirements for the state's nursing homes, to address the problem of resident-to-resident incidents that result in injury. The guidelines include greater screening of potential residents and increased staff training.

Also on Tuesday, the Alzheimer's Association issued a statement saying the new study should alert nursing home staffs to the problem of resident-to-resident injury, and the need for greater efforts to ensure safety.

The study results don't surprise Mary Jann, a spokeswoman for the California Association of Health Facilities, a trade organization representing nursing homes. During the past decade, she says, nursing homes have evolved from a social model to a medical model. "We have people who are sicker, and their nursing needs are more complex. We are seeing people with significant cognitive impairment."

Her advice for family members placing a loved one in a nursing home who is cognitively impaired: "Talk to the nursing home staff, and find out if they are geared to people with" such problems.

More information

To learn about Alzheimer's disease, visit the Alzheimer's Association. For information on choosing a nursing home, see the California Association of Health Facilities.

SOURCES: Paul I. Dreyer, Ph.D., associate commissioner, Center for Quality Assurance and Control, Massachusetts Department of Public Health, Boston; Mary Jann, California Association of Health Facilities; Feb. 3, 2004, news release, Alzheimer's Association; Feb. 4, 2004, Journal of the American Medical Association
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