What Is Known About Dementia Care Recipient Violence and Aggression Against Caregivers?

Abstract

While agitation is a known behavioral manifestation in advancing dementia, there is little in the literature about the risk to home-based caregivers, particularly in situations where severe aggression is present. This review article examines this issue with a focus on what is known and where further research is needed. Although consistent definitions failed to emerge from the literature, rates of violence by dementia care recipients against caregivers are estimated at greater than 20%, and may be the strongest predictor of nursing home placement. A review of available literature suggests that there is a need for interventions aimed at strategies to educate and protect the informal caregivers of dementia patients living at home, while advancing understanding of the communicative properties of behavior. With high rates of violence by care recipients against their caregivers, and low success rates of chemical restraints, there is substantial risk to the safety and well-being of caregivers. Several pilot interventions for nursing home settings have shown promise in reducing care recipient violence, and these may be adaptable for informal caregivers in home-based settings. Alternative delivery platforms using technology may be appropriate to consider, for real-time, flexible targeted intervention and support.

Patient Aggression in Real Time on Geriatric Inpatient Units

“…Ahmed (2012) and Scott, Ryan, James, and Mitchell (2011) reported that nurses in Jordan who had been exposed to aggression had many of the similar symptoms as nurses exposed to aggression elsewhere. Several studies address the psychological trauma and fear for personal safety as a result of assault in dementia units (Bostrom, Squires, Mitchell, Sales, & Estabrooks, 2012;Graneheim et al, 2012;Irvine et al, 2012;Lanza, Rierdan, Forester, & Zeiss, 2009;Moylan et al, 2014;Vickland et al, 2012aVickland et al, , 2012bWharton & Ford, 2014).…”

Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia

“…Table 2 lists some commonly noted environmental and interactional factors which may trigger development of aggression (Dettmore et al, 2009; Fleming & Purandare, 2010; Norton, Allen, Snow, Hardin, & Burgio, 2010; Wharton & Ford, 2014). …”

“…Consequently, it is becoming increasingly important for primary care and general outpatient practice providers to be able to effectively care for this population. One area of particular concern is the presence of neuropsychiatric behaviors, as they have been estimated to be present in up to 90% of individuals with dementia (Steinberg et al, 2003; Wharton & Ford, 2014). In particular, aggression can be particularly hard to manage because it creates risk of harm for both formal and informal caregivers and options for medical intervention are complex and situation dependent (Morgan et al, 2013).…”

Social problems in daily life of patients with dementia

“…Violence is also relatively rare in the MCI stage, but becomes more common as cognitive function deteriorates. Severe aggression by dementia care recipients toward caregivers is estimated at >20%, and is the strongest predictor of nursing home placement . Therefore, as cognitive functions deteriorate, the frequency of violence might increase.…”