Aggression between nursing-home residents more common than widely believed

When people hear about elder abuse in nursing homes, they usually think of staff members victimizing residents. However, research by Cornell University faculty members suggests that a more prevalent and serious problem may be aggression and violence that occurs between residents themselves.

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, says Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology. He has co-authored two articles -- in Aggression and Violent Behavior and in the Journal of the American Geriatrics Society -- 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.

"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.

"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.

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.

"At present, staff have few solutions available to them and typical interventions in the nursing home may have negative consequences for aggressive residents, including the use of psychotropic medications or isolation of the resident," said Lachs, co-chief of geriatrics at Weill Cornell. "We hope our work will help inspire a vigorous search for programs that work to prevent aggression and violence among residents in long-term care."

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