A new study has identified modifiable context and care worker factors associated with aggressive behavior of nursing home residents toward staff. According to Karin Stutte, MScN, of Solothurn’s Hospital AG, Switzerland, and fellow researchers, aggressive behavior from nursing home residents against care workers is a distressing and often unacknowledged experience. “Previous studies have linked differences in prevalence not only to the individual histories of the residents, or the details of their injuries, psychological states, or dementia, but also to a range of context factors (i.e., factors related either to the nursing home setting or to individual care workers),” Stutte and colleagues wrote (Geriatr Nurs 2017;38:398–405).“Identifying context and care worker factors’ relationships with aggressive behavior would support recommendations for interventions to reduce residents’ aggression.” Their study detailed the prevalence of three types of aggressive behavior by residents toward care workers in Swiss nursing homes, and examined the relationship of context and care worker factors with the aggressive behaviors. The researchers defined aggressive behavior as any nonaccidental overt act involving the delivery of noxious stimuli toward an object, oneself, or another person. The types of aggression could be verbal, physical, or sexual. The researchers performed a secondary data analysis of the Swiss Nursing Homes Human Resources Project, a representative multicenter study with a cross-sectional design. They collected data from May 2012 to April 2013 and surveyed care workers by use of a self-report questionnaire. The analysis included 155 nursing homes that housed 402 units and employed 3,919 care workers. The mean age of the residents was 85 years, with 62% displaying symptoms or having a diagnosis of dementia. The mean care worker was 43 years old, and 92% were female. During the 4 weeks preceding the survey, the researchers found that 66% of care workers had been verbally assaulted, 42% had been physically assaulted, and 15% had been the focus of sexual aggression. For the care workers who were exposed to aggression, most experienced it less than once a week. The care workers reported a lower likelihood of experiencing verbal, sexual, or physical aggression if they were older or they worked in non–special care units versus special care units, or if they perceived their facility to be well staffed, with adequate resources. Sexual aggression was less likely to be experienced by male workers or by staff who characterized their working style as autonomous. Verbal aggression was more likely to be experienced by workers who perceived they had good or very good collaboration among team members. Both verbal and physical aggression were more likely to be experienced by staff who were emotionally exhausted. Compared with tertiary-level care workers, certified nursing assistants and nurse aides had an increased likelihood of reporting physical aggression. “Intervention studies should assess whether strategies that modify context factors (e.g., campaigns to tackle the roots of low perceptions of staffing and resource adequacy, or to increase work autonomy) should also facilitate aggression reduction,” the researchers wrote. “Since our study points to the higher exposure of care workers on [special care units] to aggressive behavior, it is vital to choose care workers whose personal characteristics best match the needs of specialized units, and to adequately train and supervise them in aggression management.” Brian Ellis is a freelance writer and editor based in NJ.
39Factors associated with aggressive behavior between residents and staff in nursing homes
Factors associated with aggressive behavior between residents and staff in nursing homes
Resident-Resident Sexual Aggression Explored
ORLANDO — Sexually aggressive behavior might be common between nursing home residents, according to a focus group study. Most sexual aggression against older adults occurs in long-term care facilities rather than in community settings, according to previous case series. “Very little direct research exists [regarding] what we've begun to call RRSA or resident-to-resident sexual aggression,” said Tony Rosen, who conducted the research within the division of geriatrics and gerontology of Cornell University, New York. Fellow residents are the most common perpetrators of sexually aggressive behavior, not nursing home staff, as sometimes reported in the media, Mr. Rosen said at the annual meeting of the American Geriatrics Society. Among 103 participants in 16 focus groups including nursing home employees and some residents, 38% of participants in 18% of the focus groups reported having witnessed sexually aggressive behavior. Inappropriate touching was the most commonly reported behavior in the study, mentioned in 38% of focus groups by 7% of participants. Residents attempting to get into the bed of another (13% of groups and 18% of participants) and verbal sexual abuse (13% of groups and 5% of participants) were the next most frequent incidents reported. A behavior cited in the focus groups that surprised the researchers was inappropriate caregiving, mentioned in 6% of groups and by 3% of participants. “Inappropriate caregiving is residents trying to give intimate nursing care to other residents, a phenomenon we did not expect,” Mr. Rosen said. The focus groups included 7 cognitively intact residents and 96 clinical and nonclinical employees from all three shifts at a single, large, not-for-profit long-term care facility. The descriptions of witnessed sexually aggressive behavior came from a larger focus group study evaluating overall resident-to-resident verbal and physical aggression. “Prevention and management [of these behaviors] are more challenging due to legitimate and increasingly recognized need for sexual expression by nursing home residents,” said Mr. Rosen, a medical student at Cornell. Mr. Rosen and his colleagues defined RRSA as “negative sexual interactions between long-term care residents, that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient.” The researchers also elicited reasons or triggers for RRSA. For example, a resident mistaking another for his or her spouse was reported by 13% of groups and 8% of participants. Cognitive impairment and wandering each were cited as reasons in 13% of groups and by 5% of participants. “This is a very challenging issue,” Mr. Rosen said. “And sexual aggression can be a very charged topic.” He recommended that these behaviors be studied and understood in the context of brain disease and agitation-related behaviors. Resident rooms were the setting for the sexually aggressive behavior mentioned by 13% of groups and 2% of participants. Similarly, nursing home dining rooms were mentioned by 13% of groups and 1% of participants. Somewhat surprisingly, Mr. Rosen said, 6% of groups and 3% of participants also said they saw sexual aggression in main lounges or television viewing areas. A meeting attendee asked about sexual aggression between residents in assisted living facilities. “Right now, we are looking at skilled nursing facilities specifically,” Mr. Rosen said. “But unequivocally, we agree this happens as much or more in assisted living facilities.” “We hope to better comprehend and prevent this in the future,” Mr. Rosen said. The group he worked with developed a questionnaire to perform more qualitative research on RRSA. Damian McNamara is with the Miami bureau of Elsevier Global Medical News.
Read more772The relationship among bullying, victimization, depression, anxiety, and aggression in elementary school children
The relationship among bullying, victimization, depression, anxiety, and aggression in elementary school children
37Experiments in televised violence and verbal aggression: two exploratory studies.
Within the scarce literature concerning verbal aggression, there is some indication that verbal and physical aggression may have similar inhibitions conditioned to each. Two experiments were carried out to explore this possible relationship. In the first, middle and lower socioeconomic status (SES) adolescent boys were exposed to televised physical aggression with and without consequences to the victim shown. In the second experiment, middle and lower SES adolescent boys were exposed to televised verbal and physical aggression. For both studies, intensity of post-viewing verbal and physical aggression was measured. The hypothesized relationship between physical and verbal aggression was minimally supported. In only the second study was the previously well documented stimulative effect of viewing television violence clearly shown. Several questions are raised and research directions are suggested to better understand verbal aggression as it is related to physical aggression and televised violence.
Read more287Cross-cultural evidence of female indirect aggression
Three types of aggressive behavior (physical, verbal, and indirect) were investigated by help of peer estimations based on The Direct and Indirect Aggression Scales (DIAS) (Finland: Abo Akademi University) [Bjorkqvist et al., 1992b]. Aggressive behavior of adolescents of three age groups (8, 11, and 15 years old), in Finland, (Finnish and Swedish speakers),Israel (secular and religious Israelis),Italy,and Poland were studied (n=2094). Indirect aggression was, in proportional terms, the aggressive style mostly used by girls, across nations, ethnic groups, and age groups studied. Verbal aggression was their second most used: style, and physical aggression was applied least often by girls. Among boys, indirect aggression was, in all ages, the least used aggressive style. Physical and verbal aggression was, by boys, used equally often at ages 8 and 11, while, at the age of 15, verbal aggression had surpassed physical aggression and was the most used style. Scores of victimization to other's aggression showed somewhat similar trends.
Read more8Prevalence and Associated Factors of Physical, Verbal and Relational Aggression among Iranian Preschoolers
ObjectiveChildhood aggression may lead to severe social disorders in adolescence and adulthood. Different psychiatric approaches are focused on preschool aged aggressive children. The aim of this study was to estimate the prevalence and associated factors of childhood direct and indirect aggression.MethodsIn this cross sectional study a total of 1403 children attending 43 kindergartens were assessed. Data were collected through a structured 46-item questionnaire investigating symptoms of physical, verbal and relational aggression which was completed by parents and teachers of day-care centers. Complex sample survey analysis and multivariate logistic regression method were used for data analysis.ResultsAccording to parents’ rating, the prevalence of physical,verbal and relational aggression, was 9.9% (95% CI=7.4%-12.4%), 6.3% (95% CI=5.0% -7.6%) and 1.6% (95%CI=1.0%-2.2%), respectively; while based on teachers’ rating the prevalence of physical,verbal and relational aggression were 10.9% (95% CI=8.9% -12.9%), 4.9%(95% CI=3.8% -6.0%) and 6% (95% CI=4.4% -7.6%), respectively. A wide range of family environment factors including living with a single parent, having a working mother, death of someone close to the child, and having less educated mother were significantly associated with different types of aggression; additionally, there was some evidence of a relationship between sex of the children and physical aggression, after controlling for other variables (p < 0.05).ConclusionThis study revealed that children's family environment alongside internal factors plays an important role as an external factor in determining the child's potential aggressive behavior. Given this, to better prevent the aggressive behavior of children, intervention strategies should be planned for families and caregivers; specially mothers should receive training to use such strategies.
Read more86Trends in Mental Health Admissions to Nursing Homes, 1999–2005
The study examined 1999-2005 data on first-time nursing home admissions of individuals with mental illness, dementia, or both to identify trends and characteristics. The Minimum Data Set was used to estimate the number and percentage of persons newly admitted to nursing homes who had mental illness (schizophrenia, bipolar disorder, depression, or an anxiety disorder), dementia, or both from 1999 to 2005. Data from 2005 were used to compare demographic characteristics and comorbid conditions of the three groups and treatments received. The number of individuals admitted with mental illness increased from 168,721 in 1999 to 187,478 in 2005. The 2005 number is more than 50% higher than the number admitted with dementia only (118,290 in 2005). The increase was driven by growth in admissions of persons with depression--from 128,566 to 154,262 in 2005. Persons admitted with depression had higher rates of comorbid conditions than those admitted with dementia or with neither dementia nor mental illness. They also had high rates of antidepressant treatment and high rates of receipt of training in skills required to return to the community. Current trends show that the proportion of nursing home admissions with mental illness, in particular depression, has overtaken the proportion with dementia. These changes may be related to increased recognition of depression, availability of alternatives to nursing homes for persons with dementia, and increased specialization among nursing homes in the care of postacute, rehabilitation residents. In light of these trends, it is critical to ensure that nursing homes have resources to adequately treat residents with mental illness to facilitate community reintegration.
Read more12Televised violence and related variables as predictors of self‐reported verbal aggression
This study explored the relationship among several predictors of verbally aggressive behavior. Of these, the exposure to televised models of verbal and physical aggression were thought to be of greatest importance. The results of the study confirmed recent theoretical and research evidence concerning predictors of aggression such as predisposition for aggressive behavior, sex, and exposure to real life aggression. The study did not, however, find any support for an association between exposure to televised violence and aggressive behavior.
Read more111Potentially modifiable resident characteristics that are associated with physical or verbal aggression among nursing home residents with dementia.
Physical aggression by nursing home residents is a burden to residents and staff. The identification of modifiable correlates would facilitate developing preventive strategies. The objectives of the study were to determine potentially modifiable resident characteristics that are associated with physical aggression and to correlate these characteristics with verbal aggression. This was a cross-sectional study of nursing home residents in 5 states who had at least 1 annual Minimum Data Set assessment completed during 2002. Case subjects were defined as nursing home residents 60 years and older with dementia who were reported to have been physically aggressive in the week before their assessment. Control subjects were all other residents 60 years and older with dementia. The main outcome measure was being physically aggressive during the past week. A total of 103 344 residents met study criteria, of whom 7120 (6.9%) had been physically aggressive in the week before their annual Minimum Data Set assessment. After adjustment for potential confounders, including age, sex, severity of cognitive impairment, and dependence in activities of daily living, physical aggression was associated with depressive symptoms (adjusted odds ratio [AOR], 3.3; 99% confidence interval [CI], 3.0-3.6), delusions (AOR, 2.0; 99% CI, 1.7-2.4), hallucinations (AOR, 1.4; 99% CI, 1.1-1.8), and constipation (AOR, 1.3; 99% CI, 1.2-1.5). Urinary tract infections, respiratory tract infections, fevers, reported pain, and participation in recreational activities were not significantly associated with physical aggression in multivariate analyses (P >.01 for all). Except for constipation, the correlates of verbal aggression were similar to those of physical aggression. If the associations we have estimated are causal, then treatment of depression, delusions, hallucinations, and constipation may reduce physical aggression among nursing home residents.
Read more21Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans.
Hostility, anger, and aggression are conceptually related but unique constructs found to occur more often among veterans with posttraumatic stress disorder (PTSD) than among civilians or veterans without PTSD. However, the pathways between PTSD, depression, hostility, anger, and aggression have not been comprehensively characterized. Therefore, drawing on a sample of returning Operation Enduring Freedom/Operation Iraqi Freedom combat veterans ( N = 175; 95% male; mean age 30 years), this study sought to examine the direct and indirect relationships among PTSD, depression, hostility, anger, and four types of aggression: verbal, and physical toward self, others, and objects. Functional modeling of direct effects was done using multiple least-squares regression and bootstrapped mediation analyses were carried out to test indirect effects. Results indicate that PTSD is not the overall direct contributor to different forms of aggression, supporting the mediating role of depression and trait anger. Depression symptoms explain part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward self and trait anger explains part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward others. Our findings support the importance of assessing for anger, depression, and different types of aggression among veterans presenting for PTSD treatment to develop individualized treatment plans that may benefit from early incorporation of interventions.
Read more21Caregiver Reactions to Aggressive Behaviors in Persons With Dementia in a Diverse, Community-Dwelling Sample.
Purpose: To describe caregiver challenges with and confidence managing three aggressive behavior types in persons with dementia: verbal aggression, destroying property, and threatening to hurt others. Design and Method: Secondary analysis of baseline data from the 2001-2004 Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) initiative. Results: One or more aggressive behaviors within 1 week were reported by more than a third of caregivers, with most expressing upset but fewer expressing confidence managing the behaviors. Caregiver distress and confidence differed by race/ethnicity in response to verbal aggression, with more White/Caucasian caregivers expressing upset than Hispanic/Latinos or Black/African Americans. Fewer Hispanic/Latinos expressed confidence managing verbal aggression, compared with White/Caucasians or Black/African Americans. Discussion: Aggressive behaviors challenge caregivers, with reactions varying by behavior type and race/ethnicity. Cultural and contextual factors suggest the need to tailor interventions, especially skill-building interventions that increase confidence managing aggressive behaviors while decreasing upset.
Read more132Different forms of aggression among inner-city African–American children: Gender, configurations, and school social networks
Different forms of aggression among inner-city African–American children: Gender, configurations, and school social networks
Read more93Prevalence and correlates of aggressive behaviours occurring in patients with Alzheimer's disease.
To determine the prevalence and clinical correlates of verbal and physical aggression occurring in Alzheimer's disease sufferers. A retrospective note review was performed to classify the subjects according to whether they were verbally or physically aggressive (assaultive) or non-aggressive. The characteristics of the three groups were compared. The subjects were 262 patients who were living in non-institutional settings and had been diagnosed as suffering from dementia of Alzheimer's type. Fifty-two per cent exhibited some aggressive behaviour. Ninety-one (35%) patients were reported to be verbally aggressive and a further 46 (18%) were assaultive to their carers. Male gender (relative risk 2.17, 95% confidence interval 1.11-4.17) and the presence of dyspraxia (relative risk 2.89, 95% confidence interval 1.43-5.88) both increased the likelihood of assaultive behaviour. Verbal aggression was not associated with any of the clinical features measured. Aggressive behaviour is a common phenomenon in AD and approximately one in five sufferers is assaultive. Assaultive behaviour is associated with male gender and dyspraxia.
Read more44Correlates of verbally aggressive communication in adolescents
This investigation identifies demographic, media, and social correlates of verbally aggressive communication in adolescence. Mail surveys were completed and returned by 2,300 adolescents between the ages of 13 and 15. These adolescents were asked about the prevalence of verbal and physical aggression, the context in which it occurred, demographics, and the interpersonal and media influences in their lives. The results indicate that verbal aggression is widespread, that committing and experiencing verbal aggression is largely reciprocal, that there is a strong relationship between committing verbal and physical aggression, and that peer social influence and listening to violently oriented music are mildly related to verbal aggression in adolescents. These findings suggest more resources should be allocated to teaching adolescents to understand and control verbal aggression. Further, they provide important answers to many prevention and intervention programmatic questions, including context, content, and targeting concerns. Since the negative consequences of verbal aggression are severe and long lasting, decreasing this destructive communication behavior should significantly improve the lives of many adolescents. These and other practical implications are expanded upon and discussed.
Read moreThe use of behavioural reinforcement in the management of behaviours of concern associated with dementia.
Introduction People with dementia often require high-level care due to behaviours that are associated with dementia such as verbal and physical aggression. Behavioural therapies that utilise approaches such as behavioural reinforcement are one possible strategy to manage such behaviours.Aims The objective of this review was to synthesise the best available evidence in relation to the use of behavioural reinforcement in the management of behaviours associated with dementia. Types of participants Participants were adults aged over 60 years who had a clinical diagnosis of dementia and who exhibited any of the following behaviours associated with dementia e.g. verbal and physical aggression, vocalisations and wandering.Types of intervention Any behaviour therapy modality that used reinforcement techniques was considered.Types of outcomes The outcome of interest was a change in the behaviour associated with dementia.Types of studies Any quantitative or qualitative study designs were considered. In the absence of high quality studies, designs such as case series were considered.Search strategy The search strategy aimed to find both published and unpublished studies using a three-step approach. Papers were limited to the English language and a date restriction of 1990 to 2009 was set. Critical appraisal Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Disagreements that arose between the reviewers were resolved through discussion.Data extraction Quantitative data was extracted from papers included in the review using a standardised data extraction tool.Data synthesis Only quantitative papers met the review's inclusion criteria and were subsequently included. Due to the heterogeneity in the study design, populations, interventions and outcomes of papers, meta-analyses could not be undertaken. A narrative summary of each paper is thus provided.Results Only five papers were included; one repeated measures quasi-experimental study, three case series and one case report. Priority was given to the quasi-experimental study due to its design and quality score. The methodological quality of the other papers was weak. In total only eleven subjects were included that focussed on different schedules of reinforcement and different behaviours. The quasi-experimental study did not demonstrate significant results between presenting a visual stimulus continuously or intermittently and wandering. The preliminary evidence from the case series/report all reported a reduction in the undesirable behaviour following implementation of a reinforcement method.Conclusions Due to the evidence currently available, the utilisation of reinforcement approaches to assist in reducing or eliminating behaviours associated with dementia can be neither recommended nor refuted.Implications for practice There is weak evidence to suggest that implementing a reinforcement schedule may reduce behaviours such as physical or verbal aggression and vocalisations. The evidence for wandering is equivocal. Making a decision to utilise this type of behavioural approach should be based on clinical judgement, the preference of the patient or family and the context in which the care is delivered.Implications for research Due to the limited available evidence on this topic that can only provide weak empirical evidence, further experimental investigations such as controlled trials should be conducted to test the hypothesis that reinforcement strategies may assist in reducing or eliminating behaviour/s associated with dementia.
Read more
Copyright 2026 Cactus Communications. All rights reserved.
