URSING HOME RESIDENTS COMprise one of the most vulnerable populations due to their physical disability and cognitive impairment. Despite long-term efforts, it has been difficult to ensure the quality of care for this vulnerable population. 1,2 Although the definition of quality of care varies among professionals, 1-5 safety is one of the most important aspects of quality of care in long-term care settings in which patients are often physically and/or cognitively dependent on others. 1 Although efforts have been made to limit unintentional injury to this population, 6-8 nursing home residents are also vulnerable to intentional injury. Much concern has been expressed about the vulnerability of this population to abuse by staff, 9-14 but there is little attention regarding aggression by other residents. Prior studies have suggested that resident and facility characteristics associated with physically aggressive behavior by residents include male sex, dementia, psychosis, and pain; facility characteristics such as having a higher proportion of residents with dementia were also found to have a positive association. 15-22 According to data collected by the Centers for Medicare and Medicaid Services, approximately 88000 nursing home residents in the United States have exhibited physically aggressive behavior in the week prior to their assessment with the Minimum Data Set (MDS). 23 However, there are currently no data, to our knowledge, that delineate the characteristics of those who are injured by other residents' aggressive behavior. Therefore, we conducted a casecontrol study using data from the Massachusetts Department of Public Health's Complaint and Incident Reporting System and from MDS assessments to provide a broad examination of the types of injuries that result from resident-to-resident violent incidents; anatomical locations of injuries; location in nursing home facilities in which such injuries occurred; circumstances surrounding the incidents; and resident character

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Objective:To evaluate trends in hospitalization after injuries in the USA.Design:National Hospital Discharge Survey data from 1979 to 2000 were evaluated annually by age group, sex, injury severity score (ISS), length of stay, and discharge destination.Setting and subjects:National probability sample of hospitalized patients.Interventions:None.Main outcome measures:Incidence, duration, outcome, and population based rates of hospital admission after injuries.Results:The number of young males admitted to hospitals after injuries has decreased dramatically; older females are now the group most frequently admitted. Total days in the hospital have decreased in all age groups, but have declined less in the older population than in the younger population; furthermore, most patients aged 65 and over were formerly discharged home, but now most are discharged to long term care facilities. Overall hospitalization rates after injury have decreased in all age groups, but have declined less in the older population; furthermore, male and female hospitalization rates for serious injury (ISS at least 9, excluding isolated hip fracture) are decreasing in younger age groups while increasing in older age groups.Conclusions:Older patients comprise a growing proportion of injuries requiring hospitalization. Trauma systems must address this change, and preventing injuries in older people is increasingly important.

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