Elder Abuse in Nursing Homes: Do Special Care Units Make a Difference? A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project

Abstract

Background: In special care units (SCUs) for residents with advanced dementia, both personnel and organizations are adapted to the needs of residents. However, whether these adaptations have a preventive effect on elder abuse has not yet been explored. Objective: To describe the prevalence of observed emotional abuse, neglect, and physical abuse in Swiss nursing homes, to compare SCUs with non-SCUs concerning the frequency of observed emotional abuse, neglect, and physical abuse, and to explore how resident-related characteristics, staff outcomes/characteristics, and organizational/environmental factors relate to observed elder abuse. Methods: This is a secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP), a cross-sectional multicenter study. Data were collected from 2012 to 2013 and are based on observed rather than perpetrated elder abuse. We performed multilevel mixed-effects logistic regressions taking into account the hierarchical structure of the data with personnel nested within units and facilities. Results: Of 4,599 care workers in 400 units and 156 facilities, 50.8% observed emotional abuse, 23.7% neglect, and 1.4% physical abuse. There was no significant difference between SCUs and non-SCUs regarding observed emotional abuse and neglect. Higher scores for ‘workload' and sexual aggression towards care workers were associated with higher rates of emotional abuse and neglect. Verbal and physical resident aggression, however, were only associated with higher rates of emotional abuse. Negative associations were found between ‘teamwork and resident safety climate' and both forms of abuse. Conclusion: Improving teamwork and the safety climate and reducing work stressors might be promising points of intervention to reduce elder abuse. More specific research about elder abuse in SCUs and the interaction between work climate and elder abuse is required.

Elder abuse in Norwegian nursing homes: a cross-sectional exploratory study

“…Psychological abuse is reported as the most prevalent type of abuse in many studies [21,25,[27][28][29], and we also found a high prevalence rate of both observed and perpetrated psychological abuse. The most frequently reported act in our study was staff yelling at a resident, which is consistent with prevalence rates reported by nursing home staff in the Czech Republic [29] and by nurses in German nursing homes [27], but quite in contrast to the low rate found in Irish nursing homes [24].…”

“…Different data collection methods are also a significant cause of the variability in estimates, where most measurement instruments are self-designed and studyspecific [12]. The use of different reference periods might also impact the prevalence, where some studies use a four week period [25], while others use three months [21][22][23] or even the entire work career [26]. Nevertheless, a past-year reference period is the most commonly used [24,[27][28][29][30][31][32][33].…”

“…Few studies have been conducted on risk factors of elder abuse in institutional care settings [37], and existing research is ambiguous when describing the individual-level risk factors of staff. For instance, in Irish nursing homes, male staff reported committing more acts of neglect than their female colleagues [24], and in Swiss nursing homes, men admitted more acts of emotional abuse [25]. In Taiwan, younger staff committed more psychological abuse [38], and in Norway, older staff reported more acts of physical abuse [26].…”

Factors Affecting Mistreatment of the Elderly in Long-Term Care Facilities

“…The majority of perpetrators were male workers [4,15], and mistreatment was related to their level of education and nursing care skills [16,17]. There are no consistent findings between period of work and mistreatment.…”

“…Other studies reported that a shorter work period increases abusive behavior [18]. Abusive behaviors were closely associated with a high workload and levels of work stress [15,19]. Previous studies conducted a survey of care workers working in a nursing home or group home to determine the relationship between the work environment factors and care workers' awareness of mistreatment and abusive behavior [17,20].…”