Aggressive behaviour of persons with dementia towards professional caregivers in the home care setting—A scoping review

Abstract

Aims and objectives To outline and to examine the current research and grey literature on aggressive incidents of persons with dementia towards professional caregivers in the home care setting. We intended to identify evidence and research gaps in this field. Background Worldwide, around fifty million people are living with dementia. Current research indicates that aggressive behaviour of persons with dementia towards professional caregivers occurs frequently in inpatient settings. However, there has been little research on this phenomenon in the home care setting. Design The design entails a scoping review using the methodological framework of Arksey and O’Malley and PRISMA‐ScR. Methods A systematic literature search in five databases and a web search in Google Scholar was conducted. Title and abstract screening and a full‐text screening were conducted by two independent authors. A free web search for grey literature was conducted in Google. Results The search yielded 1,376 hits. A total of seven journal articles met the inclusion criteria. In the free web search, six references were identified for inclusion, resulting in a total of 13 references. We identified the following four themes: (1) aggressive behaviour in the context of dementia, (2) triggering factors of aggressive behaviour in persons with dementia, (3) skills and educational needs and (4) hindrances to solving the problem of aggressive behaviour. Conclusions There is a lack of literature on aggressive behaviour of persons with dementia in the home care setting, and various hindrances to solving this problematic behaviour have been identified. Relevance to clinical practice For home caregivers, specific education concerning communication skills and responding to aggressive behaviour may help to deal with the situation. A further approach may involve specific training aimed to improve caregivers’ confidence.

Experience of aggressive behaviour of health professionals in home care services and the role of persons with dementia

“…The most reported triggering factors in incidents with persons with dementia were misunderstanding of the situation on behalf of the client, overstrain and confusion. These insights are in line with the results of a current review on the topic (Schnelli et al., 2020). However, it is surprising that in the reported aggressive incidents with a person with dementia as perpetrator, dissatisfaction with the care or the therapy is significantly less often a triggering factor than when the perpetrating client had no dementia.…”

“…Hence, the assumption noted in the scoping review of Schnelli et al. (2020) that dementia or decline in cognitive abilities in the clients is a predisposing factor for the occurrence of aggressive behaviour in home care settings is substantiated.…”

“…Underreporting is a phenomenon discussed in this topic (Hahn et al., 2010). However, the hints provided by the results about the frequency of aggressive incidents allow the assumption that the number is higher because there are barriers to reporting aggressive incidents, such as not recognizing aggression (Schnelli et al., 2020). Further, dementia is underdiagnosed in home care services (Genet et al., 2012).…”

“…Besides these issues, workplace violence is a further challenge to be dealt with (Hanson et al., 2015). Violence against home care nurses seems to occur particularly in persons with dementia (Fitzwater & Gates, 2000; Galinsky et al., 2010; Schnelli, Karrer, Mayer, & Zeller, 2020). However, there is little research on dementia‐related aggression in home care services.…”

“…supporting during personal hygiene or unmet needs like urinary urgency, hunger or social needs, Schnelli et al., 2020). However, in what way dementia influences the occurrence of aggressive behaviour and which are the relevant triggering factors is currently not known (Schnelli et al., 2020).…”