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Study Cites Aggressive Nursing Home Residents

Shouting, pushing, bullying are common, researchers find

June 4, 2008

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Many people worry about their aging relatives who live in nursing homes. But while their concerns often focus on fear of their loved ones' mistreatment by staff, new research suggests they should also be worried about other elderly residents.

Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology, led a research team exploring violence and aggression in nursing homes. They didn't expect what they found.

"Anyone who spends much time in a nursing home will observe arguments, threats and shouting matches among residents, as well as behaviors like pushing, shoving and hitting," Pillemer said.

Just because the residents are elderly, it doesn't mean they are docile. In fact, the effects of aging and medication – or lack of it – can sometimes make the institutionalized elderly grumpy, and more than a little unpredictable.

"Given that nursing homes are environments where people live close together, and many residents have lowered inhibitions because of dementia, such incidents are not surprising," he said. "Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem."

The studies found 35 different types of physical and verbal abuse between residents at a large urban nursing home. Screaming was the most common form of aggression, followed by such physical violence as pushing and punching or fighting.

Although such aggression can have serious consequences for both aggressors and victims, the issue has received little attention from researchers, and few proven solutions exist to prevent resident altercations, Pillemer says.

Pillemer has co-authored two articles on "resident-to-resident mistreatment" this spring with Weill Cornell Medical College professor of medicine Mark S. Lachs, M.D., and medical student Tony Rosen. Both studies report that verbal and physical aggression between residents is common and problematic, and that more research is necessary to identify risk factors and preventative measures.

In related work, the authors found that 2.4 percent of residents reported personally experiencing physical aggression from another resident and 7.3 percent reported experiencing verbal aggression over just a two-week period. Most respondents rated the events as moderately or extremely disruptive to daily activities.

In another study, 12 nurse-observers identified 30 episodes of resident-to-resident aggression on just a single eight-hour shift, 17 of which were physical.

Research also indicates that victims are more likely to be male, have behavioral problems like wandering and be cognitively impaired.

While such incidents are difficult to prevent, these types of studies will help nursing-home staff manage aggression among patients, Pillemer said.

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