The circumstances surrounding the death of 105 elders as a result of resident-to-resident incidents in dementia in long-term care homes

Abstract

Resident-to-resident incidents in dementia in long-term care homes resulting in deaths represent a growing concern among residents, family members, care providers, care advocacy organizations, and policy makers. Despite these concerns and experts' predictions by which injurious and fatal incidents will increase in the coming years due to the projected growth in the number of people with dementia, no studies have been conducted in North America on these fatal incidents. This exploratory pilot study makes first steps towards bridging this major gap in research and practice. Using publicly available information (primarily newspaper articles and death review reports), practically useful patterns were identified pertaining to the circumstances surrounding the death of 105 elders as a result of these incidents. The findings could inform various efforts to prevent future deaths in similar circumstances, keep vulnerable and frail residents safe, and encourage researchers to examine risk and protective factors for these incidents.

Resident-to-resident aggression in Norwegian nursing homes: a cross-sectional exploratory study

“…Compared to research on elder abuse committed by healthcare staff [3], and the violence directed toward caregivers by nursing home residents [4][5][6][7], few studies have examined the occurrence of aggression that occurs between residents in long-term care facilities [2,8,9]. Such aggression has been associated with a range of serious health consequences, from minor bruises to fatal injuries, psychological distress, poorer quality of life, and an increased risk of hospitalisations and premature death [2,8,[10][11][12]. Resident-to-resident aggression may also create an unsafe and stressful working environment for healthcare staff [8,13].…”

“…The term "abuse" may also be more stigmatising than "aggression" and hence contribute to concerns of underreporting [1]. Previous research has used different terms to describe residents displaying aggressive behaviours such as "exhibitors" [11,15], "perpetrators" [1,16], "initiators" [2,17], and "aggressors" [10]. Furthermore, prior research has used a variety of terminologies including resident-to-resident abuse [2,[18][19][20], resident-toresident (elder) mistreatment [9,16,[21][22][23][24][25][26], resident-toresident relational aggression [27], resident-to-resident violence [10,17,28], and resident-to-resident (physical) aggression [8,12,13,15,[29][30][31][32].…”

“…One of the first studies on RRA was conducted in 2004 by Shinoda-Tagawa and colleagues, who performed a case-control study of the Minimum Data Set assessments for nursing home residents and of the Massachusetts Department of Public Health's Complaint and Incident Reporting System, to assess risk factors of resident injury inflicted by co-residents [10]. Since then, researchers have used different study approaches to examine the extent, nature and associations including secondary analysis of existing records/registers [12,15,16,31,33] and publicly available data (media) [11], qualitative event reconstructions [30], observational designs [9], and interviews or surveys of staff [13,17,18,27,34,35], family members [19,20], and/or residents themselves [13,27].…”

“…Previous research has found that victims of RRA are both males [10] and females [16,19], cognitively impaired [10,13,16], and/or they often demonstrate neuropsychiatric symptoms (NPS) such as agitation, aggression and/or wandering (getting in harm's way) [10,13]. Aggressors are more likely to be male [11,12,15,31], younger than their victims [11,12,15], intolerant of residents with cognitive impairments [16], more physically dependent [10], and/or they suffer from cognitive impairment, dementia or mental illness themselves [10][11][12]. A higher incidence of RRA has been found in larger compared to smaller nursing homes [12], institutions located in metropolitan rather than in non-metropolitan areas [12], and in dementia special care units compared to other units [10].…”

“…A higher incidence of RRA has been found in larger compared to smaller nursing homes [12], institutions located in metropolitan rather than in non-metropolitan areas [12], and in dementia special care units compared to other units [10]. Some studies have reported that RRA is most often exhibited in shared dining/living rooms or hallways [12,13,15,16], while others have found incidents to be more prevalent in residents' rooms [10,11,13,16]. Most episodes occur in the afternoon or evening [12,13,16], and often when staff members are not present [11,15,36].…”