A recent study found that the majority of nursing home residents suffer abuse, not from attending nurses, but from fellow residents. It is, unfortunately, very common for nursing home residents to suffer abuse however the media tends to focus on the wrong perpetrators.
The study, from Weill Cornell Medicine in New York, conducted surveillance of 10 urban and suburban nursing homes in New York State covering more than 2,000 residents. The researchers observed the nursing homes for a full month, conducted interviews with staff and residents, and reviewed medical and accident charts. This is the largest systematic study of its kind that reviewed resident on resident abuse in nursing homes.
According to the study’s primary researcher, Dr. Mark Lachs, about one in five residents experience verbal or physical abuse from other residents.
The study defined the abuse the residents suffered as mistreatment. Mistreatment encompasses a range of behaviors from running people over with wheelchairs, stealing food, surreptitiously entering people’s rooms and rifling through their belongings, verbal abuse, sexual assault, and physical violence. Mainly, the study encompassed any behavior that had the potential to lead to psychological distress.
The study estimates that around 5 million elderly Americans are victimized by abuse, neglect, or exploitation. Moreover, the U.S. Department of Health and Human Services estimates that for every case of abuse reported there are 23 more that are unreported. The researchers posit that the number of mistreatment cases will only increase as the U.S. population ages.
The study found that about three-quarters of mistreatment events were verbal abuse and one-quarter were physical. The study reviewed 2,011 residents and found that 407 experienced at least one instance of mistreatment during the month that the study was conducted.
The researchers also found that nearly six percent of residents were involved in hitting, biting, or kicking other residents. Moreover, less than two percent of residents exposed themselves or made unwanted sexual advances.
More than ten percent of the residents experienced unwelcome entry into their room and pilfering of their belongings by other residents. While this behavior may seem innocuous or irritating at worse, these unwanted entries can spark angry or even violent responses and escalate the situation.
16 percent of residents experienced verbal abuse, such as screaming or cursing. The researchers also observed various situations involving of throwing objects, spitting, and scratching.
The study noted that most abusers tend to be younger, mobile, and physically capable. However, they also suffer from dementia and other mental illnesses which manifest as verbally or physically aggressive behavior.
But the researchers caution that aggression isn’t a symptom of dementia and rather a response to the frustration caused by mental illness.
The researchers suggest several solutions, including changes to the environment to reduce mistreatment rates. For instance, the researchers believe improved lighting and reduced noise, both of which aggravate residents, could reduce violence instances. The researchers also suggest that safer public and private spaces with residents who suffer from dementia could reduce resident on resident violence.
The Alzheimer’s Association further recommend limiting distractions, such as flashing or blinking lights, loud music, crowds or television, to diminish aggressive behavior in residents who suffer from mental deterioration. They also recommend relaxing activities and switching activities when residents become aggressive.
The study also suggests that shifting the culture among nursing home residents could reduce instances of mistreatment. For example, nursing staff should refrain from using force and physical restraints when addressing the aggressive resident behavior.
However, many of these problems are due to nursing homes being understaffed. In this environment, nursing attendants tend to become desensitized to violence and screaming among residents and begin to view this behavior as normal. Nursing staff should be trained to be more responsive to these types of outbursts, to minimize aggressive resident on resident interactions.
Furthermore, nursing homes are already strained by large numbers of Baby Boomers retiring. As a result, many nursing homes are accepting residents more than their housing capacity. Overcrowding tends to increase stress among residents and leads to more residents engaging in unwanted interactions.
The study also advises that nursing attendants and family take into account the mental state of the residents. For example, on a typical family visit, the family member may ask the resident a series of benign questions such as: “how are you?” and “what did you do today?” To a layperson these questions are straightforward however a patient suffering from dementia, while understanding the question, takes more time to comprehend and formulate an answer. However, many nursing attendants and family members do not give the resident sufficient time to respond, which can also foment feelings of frustration.
However, the researchers caution that additional studies are required to craft more effective solutions.