Precipitants of Elderly Psychiatric Patient Assaults on Staff: Preliminary Empirical Inquiry

Abstract

Although there have been several studies of the characteristics of psychiatric patient assailants, there have been only six comprehensive, empirical assessments of precipitants to these assaults and no precipitant study has focused solely on elderly psychiatric patient assailants. This one and one-half year, retrospective study continued the inquiry into the nature of patient assault precipitants and focused only on elderly assailants. Older, male patients with a diagnosis of schizophrenia and histories of violence toward others and substance use disorder physically assaulted primarily male, mental health workers. These staff victims experienced disruptions in the domains of mastery, attachment, and meaning as well as the symptomatology associated with psychological trauma. The most common precipitants to these assaults were denial of services and acute psychosis. The findings and implications for health care providers in long-term care settings where elderly psychiatric patients reside are discussed.

Violence in older people with mental illness

“…The National Audit of Violence (Royal College of Psychiatrists' Centre for Quality Improvement 2008) has demonstrated that nursing staff are more likely to be the victims of assaultive behaviour on in-patient units than are other clinical or nonclinical staff (64% v. 20% v. 23%). Other studies have observed assaults to occur most frequently during the day shift (Astrom 2002;Flannery 2005).…”

“…The first is a younger group, either male or female, with a history of schizophrenia, substance misuse or personality disorder. The second is an older population, with a history of organic disorder or psychosis (Flannery 2005).…”

“…Community and in-patient studies in people with dementia appear to show no difference between genders, whereas studies in older people with functional mental illness seem to demonstrate that violence is more common in males (Aarsland 1996;Gormley 1998;Flannery 2005;O'Leary 2005).…”

“…Flannery et al (2005) note the dearth of studies into assaultive behaviour by older people with mental illness. The 2006 National Confidential Inquiry into Suicides and Homicides by People with Mental Illness (Appleby 2006) revealed that perpetrators of homicide in England and Wales over the age of 65 are more likely than their younger counterparts to receive a verdict of diminished responsibility, or a hospital or community rehabilitation order.…”

“…A study of elderly psychiatric patients who had attempted or committed homicide found that almost 50% had a history of alcohol misuse (Ticehurst 1992). Another study of a non-forensic elderly psychiatric in-patient population found that 74% of patients who had behaved aggressively towards staff had a history of substance misuse (Flannery 2005).…”