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Yan E, To L, Wan D, Lai DWL, Leung E, Lou VWQ, Fong DYT, Cheng ST, Chaudhury H, Pillemer K, Lachs M. Resident Aggression and Staff Burnout in Nursing Homes in Hong Kong. J Appl Gerontol 2024:7334648241272027. [PMID: 39116274 DOI: 10.1177/07334648241272027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
This study examined the effects of exposure to resident aggression, self-efficacy, neuroticism, and attitudes toward dementia on burnout among direct care workers (DCWs) in nursing homes. A convenience sample of 800 DCWs from 70 randomly selected nursing homes in Hong Kong were recruited and individually interviewed. DCWs reported past-month experiences of resident aggression, levels of burnout, self-efficacy, neuroticism, attitudes toward dementia, and other personal and facility characteristics. Hierarchical multiple regression analysis revealed that, while physical environment of the facilities, and demographic background and self-efficacy of DCWs were not significant contributing factors, DCWs' exposure to resident aggression, insufficient experience and training in dementia care, negative attitudes toward dementia, and neurotic personality were associated with higher levels of staff burnout. Findings point to the importance of mitigating resident aggression and adequately screen and train staff to optimize their empathy and competence in minimizing the risk of burnout.
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Affiliation(s)
- Elsie Yan
- The Hong Kong Polytechnic University, Hong Kong
| | - Louis To
- The Hong Kong Polytechnic University, Hong Kong
| | - Debby Wan
- The Hong Kong Polytechnic University, Hong Kong
| | | | - Edward Leung
- Hong Kong Association of Gerontology, Kowloon, Hong Kong
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Hua CL, Nelson I, Cornell PY, White EM, Thomas KS. Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias. J Am Med Dir Assoc 2024; 25:105087. [PMID: 38885933 PMCID: PMC11283979 DOI: 10.1016/j.jamda.2024.105087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To examine the relationship between changes in nursing staff-hours per resident-day and injury-related emergency department (ED) visits among assisted living (AL) residents with Alzheimer disease and related dementias (ADRD). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We leveraged a data set of AL community characteristics in Ohio linked to Medicare claims data from 2007 to 2015. METHODS We estimated Poisson models examining the relationships of personal care aide, registered nurse (RN), licensed practical nurse (LPN), and total nursing hours with injury-related ED visits. Models were adjusted for resident characteristics (ie, age, race, sex, dual eligibility, presence and number of chronic conditions), AL community characteristics (percentage of residents on Medicaid, average resident acuity), year fixed effects, and assisted living fixed effects. We examined all injury-related ED visits and injury-related ED visits resulting in hospital admission as separate outcomes. RESULTS The sample included 122,700 person-months, representing 12,144 fee-for-service Medicare beneficiaries with ADRD within 455 different AL communities in Ohio between 2007 and 2015. Median total nursing hours increased from 1.34 in 2007 to 1.69 in 2015. In the fully adjusted model, an increase in 1 RN-hour per resident-day was associated with a decrease in the risk of any injury-related ED visit (incidence rate ratio 0.59, 95% CI 0.36-0.96), representing a 53% decrease. Changes in RN-hours were not associated with injury-related inpatient hospitalizations. Changes in total nursing, LPN, and personal care aide hours were not associated with changes in the risk of injury-related ED visits or inpatient hospitalizations. CONCLUSIONS AND IMPLICATIONS Increases in RN staffing hours were associated with reduced injury-related ED use among AL residents with ADRD. RNs provide surveillance and care oversight that may help mitigate injury risk, and they are able to physically assess residents at the time of a fall and/or injury, which can preempt unnecessary ED transfers.
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Affiliation(s)
- Cassandra L Hua
- Center for Health Statistics and Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Ian Nelson
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Portia Y Cornell
- Centre for the Digital Transformation of Health/Centre for Health Policy, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elizabeth M White
- Center for Gerontology and Healthcare Research and the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Kali S Thomas
- Center for Equity in Aging, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Jang Y, Park J, Rhee MK, Lee HW, Park NS, Kim Y, Chung S, Kim MT. Mental Health Impact of Bullying by Ethnic Peers in Senior Housing: A Study with Older Korean American Residents in the Greater Los Angeles Area. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:575-587. [PMID: 38627372 PMCID: PMC11116039 DOI: 10.1080/01634372.2024.2338071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/29/2024] [Indexed: 05/24/2024]
Abstract
Using data from Korean-American residents (N = 343) in subsidized senior housing in the Los Angeles area, we examined the effect of peer bullying on mental health. About 18% of the sample had been a target of bullying, and over 31% had witnessed someone being bullied. Being a target of bullying was a significant predictor for both depressive symptoms and anxiety, whereas witnessing other residents being bullied was a significant predictor for anxiety only. Findings shed light on the adverse mental health impacts of peer bullying among ethnic minority older residents in senior housing.
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Affiliation(s)
- Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
- Department of Social Welfare, Ewha Womans University, Seoul, Republic of Korea
| | - Juyoung Park
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| | - Min-Kyoung Rhee
- Leonard Davis School of Gerontology, University of Southern California, USA
| | - Hi-Woo Lee
- Little Tokyo Service Center, Los Angeles, USA
| | - Nan Sook Park
- School of Social Work, University of South Florida, Tampa, USA
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, Arlington, USA
| | - Soondool Chung
- Department of Social Welfare, Ewha Womans University, Seoul, Republic of Korea
| | - Miyong T. Kim
- School of Nursing, University of Texas at Austin, Austin, USA
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Pillemer K, Teresi JA, Ramirez M, Eimicke J, Silver S, Boratgis G, Meador R, Schultz L, Kong J, Ocepek-Welikson K, Chang ES, Lachs MS. Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living. JAMA Netw Open 2024; 7:e249668. [PMID: 38700860 PMCID: PMC11069077 DOI: 10.1001/jamanetworkopen.2024.9668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants This study used cross-sectional, observational data from a clinical trial, in which residents of assisted living facilities were monitored for events over a 1-month period. All residents of 14 large facilities randomly selected from 2 geographic locations (N = 1067), except those receiving hospice care (n = 11), were invited to participate; 93 died or moved prior to enrollment. There were 33 family and resident refusals; 930 residents were enrolled. Data were collected between May 30, 2018, and August 11, 2022. Main Outcomes and Measures The data are from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. In addition, the study was designed to assess prevalence using the Time 1 (baseline) data, using a probability sample of facilities to allow for this analysis. Resident-to-resident aggression was identified using a mixed-method, case-finding strategy involving 6 sources: (1) cognitively capable resident reports regarding 22 possible events, (2) direct care staff report, (3) staff member reports collected from event-reporting forms, (4) research assistant observation of events in real time, (5) facility accident or incident reports, and (6) resident records. Results The prevalence of resident-to-resident aggression among the 930 participants (mean [SD] age, 88.0 [7.2] years; 738 women [79.4%]) during the past month was estimated to be 15.2% (141 of 930 residents; 95% CI, 12.1%-18.8%). The most common forms of aggression included verbal (11.2% [104 of 930 residents; 95% CI, 8.8%-14.2%]), physical (41 of 930 residents; 4.4% [95% CI, 3.1%-6.3%]), sexual (0.8% [7 of 930 residents; 95% CI, 0.4%-1.6%]), and other (70 of 930 residents; 7.5% [95% CI, 5.5%-10.2%]). These categories are not mutually exclusive as residents could be involved with more than 1 type of aggressive behavior. Conclusions and Relevance In this cross-sectional, observational prevalence study, resident-to-resident aggression in assisted living facilities was highly prevalent. Verbal aggression was the most common form, and physical aggression also occurred frequently. The effects of resident-to-resident aggression can be both morbid and mortal; therefore, intervention research is needed to prevent it and to treat it when it occurs.
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Affiliation(s)
- Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute, New York
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mildred Ramirez
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Joseph Eimicke
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Stephanie Silver
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Boratgis
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Rhoda Meador
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Leslie Schultz
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Jian Kong
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Katja Ocepek-Welikson
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
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Chang ES, Jhaveri S, Hancock DW, Teresi JA, Ramirez M, Eimicke JP, Czaja SJ, Pillemer K, Lachs MS, Rosen T. Exploring Overt Racial and Ethnic Conflict in Resident-to-Resident Aggression in Long-Term Care Facilities. J Am Med Dir Assoc 2024; 25:565-571.e1. [PMID: 39101042 PMCID: PMC11293842 DOI: 10.1016/j.jamda.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Objectives Resident-to-resident aggression (RRA) in long-term care facilities is gaining recognition as a serious problem. Racial/ethnic conflict may be a contributing factor to RRA incidents, but it remains insufficiently studied. Our goal was to explore overt racial/ethnic conflict in RRA. Design We used quantitative and qualitative secondary analyses of existing data from a large, rigorously conducted study of RRA to describe the involved residents and patterns of overt racial/ethnic conflicts. Setting and Participants The parent study included information of 2011 residents in 10 randomly selected New York State nursing homes with a wide range of racial/ethnic minority residents (4.2%-63.2%). A subset of 407 residents were involved in RRA. Methods We re-examined data from the parent study, which used an innovative approach to identify RRA incidents by reconstructing each incident based on residents' self-reports, staff interviews, field observations, and medical chart review. Resident and facility information was collected. Results A total of 35 residents (8.6% of those involved in RRA incidents) were identified as involved in overt racial/ethnic conflicts. These residents were more likely to have had less education than residents involved in other types of RRA but not in overt racial/ethnic conflicts. More than half (56.9%) of the 51 incidents of RRA involving overt racial/ethnic conflict between a specific pair of residents occurred repeatedly. Manifestation of racial/ethnic conflicts included physical violence, discrimination, racial/ethnic slurs, stereotypes, and microaggression. Acute precipitants of these incidents included various communal-living challenges and unmet needs at the facility, relational, and individual levels. Psychological and behavioral consequences were also described. Conclusion and Implications We found a broad range of manifestations, acute precipitants, circumstances surrounding, and consequences of overt racial/ethnic conflicts in RRA. Additional research is needed to improve understanding of this phenomenon and how staff may effectively intervene and prevent it.
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Affiliation(s)
- E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sonya Jhaveri
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David W. Hancock
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jeanne A. Teresi
- Research Division, Hebrew Home at Riverdale by River Spring Living, Riverdale, NY, USA
- Columbia University Stroud Center, New York State Psychiatric Institute, New York, NY, USA
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale by River Spring Living, Riverdale, NY, USA
| | - Joseph P. Eimicke
- Research Division, Hebrew Home at Riverdale by River Spring Living, Riverdale, NY, USA
| | - Sara J. Czaja
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Psychology, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
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Yan E, Wan D, To L, Ng HKL, Lai DWL, Cheng ST, Kwok T, Leung EMF, Lou VWQ, Fong D, Chaudhury H, Pillemer K, Lachs M. Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue. J Am Med Dir Assoc 2024; 25:396-402. [PMID: 37972647 DOI: 10.1016/j.jamda.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff. DESIGN Cross-sectional descriptive study design. SETTING AND PARTICIPANTS A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling. METHODS The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics. RESULTS Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention. CONCLUSIONS AND IMPLICATIONS Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.
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Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Debby Wan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Louis To
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Haze K L Ng
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong SAR, China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Daniel Fong
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Karl Pillemer
- Cornell College of Human Ecology, Cornell University, New York, NY, USA
| | - Mark Lachs
- Weill Cornell Medicine, Cornell University, New York, NY, USA
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Makaroun LK, Halaszynski JJ, Smith KA, Drake R, Amelio-Hering V, Atchison K, Dichter ME, Rosland AM, Thorpe CT, Rosen T. Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System. J Gen Intern Med 2024:10.1007/s11606-023-08560-2. [PMID: 38191973 DOI: 10.1007/s11606-023-08560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening. OBJECTIVE Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA. DESIGN Survey of all 139 VHA medical centers from January to August 2021. PARTICIPANTS Surveys were completed by the Social Work Chief, or delegate, at each site. MAIN MEASURES The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey. KEY RESULTS Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents' understanding of the definition of screening. CONCLUSIONS High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.
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Affiliation(s)
- Lena K Makaroun
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- VA Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | | | - Ruth Drake
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
| | | | - Karley Atchison
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- School of Social Work, Temple University Philadelphia, Philadelphia, PA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/New-York Presbyterian Hospital, New York, NY, USA
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Marzbani B, Ayubi E, Barati M, Sahrai P. The relationship between social support and dimensions of elder maltreatment: a systematic review and Meta-analysis. BMC Geriatr 2023; 23:869. [PMID: 38110874 PMCID: PMC10726566 DOI: 10.1186/s12877-023-04541-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION AND AIMS Many studies have investigated the relationship between social support and the prevention of elder abuse; however, their results are somehow inconsistent in terms of the association. This systematic review and meta-analysis aimed to investigate the published studies on the relationship between social support and the prevention of elder maltreatment. MATERIALS AND METHODS An electronic search was conducted until January 2023, using such databases as PubMed, Scopus, and Web of Science. The present research included cross-sectional, longitudinal, and case-control studies. Study selection, data extraction, and risk of bias assessment were conducted by two researchers independently. The Newcastle-Ottawa checklist was utilized to evaluate the quality of studies. The random effects model was employed to perform a meta-analysis. RESULTS In total, 32 studies were included in this systematic review, out of which 26 articles were eligible for meta-analysis. The results showed that 68.75% of the studies were of high quality, and there is a significant relationship between social support and elder maltreatment. Accordingly, the lack of social support increased overall maltreatment (odds ratio: 1.24, 95% confidence interval: 1.16-1.33; I2 = 92.3%, p = 0.000)). Moreover, lack of social support had an increasing effect on the level of psychological abuse (1.55, 1.18-2.04; 88.7%, p = 0.000), physical abuse (1.31, 0.42-4.11; 76.3%, p = 0.005), and neglect (2.02, 0.86-4.72; 87.9%, p = 0.000), which shows heterogeneities among the results of the included studies. On the contrary, the lack of social support showed a decreasing effect on financial abuse (0.92, 0.70-1.21; 62.1%, p = 0.022). CONCLUSION This systematic review provides evidence that social support in the form of structural or functional support may plays an important role in improving the quality of life of the elderly.
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Affiliation(s)
- Behnaz Marzbani
- Department of Public Health, School of health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Department of Public Health, School of Health, Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, 6517838695, Iran.
| | - Parvaneh Sahrai
- Department of Public Health, School of health, Hamadan University of Medical Sciences, Hamadan, Iran
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Gottesman E, Elman A, Rosen T. Elder Mistreatment: Emergency Department Recognition and Management. Clin Geriatr Med 2023; 39:553-573. [PMID: 37798065 DOI: 10.1016/j.cger.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.
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Affiliation(s)
- Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA.
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Falardeau MC, Beaulieu M, Carbonneau H, Levasseur M. Practices countering resident-to-resident aggression and promoting wellness care for older adults in congregate residential facilities: results from a systematic review. J Elder Abuse Negl 2023; 35:174-211. [PMID: 38073175 DOI: 10.1080/08946566.2023.2283746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Resident-to-resident aggression (RRA) is an important issue in congregate residential facilities (CRFs) for older adults and has devastating effects. This study aimed to provide an inventory and content analysis of the practices used to counter RRA and promote wellness care for older adults in CRFs. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, original, peer-reviewed research and systematic reviews published in 14 electronic databases and two gray literature sources were examined. Of the 6196 articles identified, 28 met the inclusion criteria. Practices aimed to prevent, track or intervene in RRA, mostly in long-term care centers, but few were evidence-based and ready for widespread implementation. It emerges that continuous training of staff is necessary and that it should prioritize a person-centered approach. CRFs' managers must promote a culture of wellness care and policymakers should consider the prevention practices to improve the quality of life of older adults in CRFs.
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Affiliation(s)
- Marie-Chantal Falardeau
- School of Social Work, Université de Sherbrooke and Research Center on Aging, Sherbrooke, Canada
| | - Marie Beaulieu
- School of Social Work, Université de Sherbrooke and Research Center on Aging, Sherbrooke, Canada
| | - Hélène Carbonneau
- Culture and Tourism Department, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Mélanie Levasseur
- School of Rehabilitation, Université de Sherbrooke and Research Center on Aging, Sherbrooke, Canada
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Shields MC, Hollander MA. Complaints, Restraint, and Seclusion in Massachusetts Inpatient Psychiatric Facilities, 2008-2018. J Patient Exp 2023; 10:23743735231179072. [PMID: 37323757 PMCID: PMC10265359 DOI: 10.1177/23743735231179072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
There has been limited research on the quality of inpatient psychiatry, yet policies to expand access have increased, such as the use of Medicaid Section 1115 waivers for treatment in "Institutions for Mental Disease" (IMD). Using data from public records requests, we evaluated complaints, restraint, and seclusion from inpatient psychiatric facilities in Massachusetts occurring from 2008 to 2018, and compared differences in the rates of these events by IMD status. There were 17,962 total complaints, with 48.9% related to safety and 19.9% related to abuse (sexual, physical, verbal), and 92,670 episodes of restraint and seclusion. On average, for every 30 census days in a given facility, restraint, and seclusion occurred 7.47 and 1.81 times, respectively, and a complaint was filed 0.94 times. IMDs had 47.8%, 68.3%, 276.9%, 284.8%, 183.6%, and 236.1% greater rates of restraint, seclusion, overall complaints, substantiated complaints, safety-related complaints, and abuse-related complaints, respectively, compared to non-IMDs. This is the first known study to describe complaints from United States inpatient psychiatric facilities. Policies should strengthen the implementation of patients' rights and patient-centeredness, as well as external critical-incident-reporting systems.
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Affiliation(s)
| | - Mara A.G. Hollander
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA
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12
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Chen P, Cai H, Bai W, Zhang Q, Su Z, Tang YL, Ungvari GS, Ng CH, Xiang YT. Global prevalence of mild cognitive impairment among older adults living in nursing homes: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry 2023; 13:88. [PMID: 36906613 PMCID: PMC10008549 DOI: 10.1038/s41398-023-02361-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 03/13/2023] Open
Abstract
Mild cognitive impairment (MCI) is the early stage of cognitive impairment between the expected cognitive decline of normal aging and the more serious decline of dementia. This meta-analysis and systematic review explored the pooled global prevalence of MCI among older adults living in nursing homes and its relevant factors. The review protocol was registered in INPLASY (INPLASY202250098). PubMed, Web of Science, Embase, PsycINFO, and CINAHL databases were systematically searched from their respective inception dates to 8 January 2022. The inclusion criteria were made based on the PICOS acronym, as follows: Participants (P): Older adults living in nursing homes; Intervention (I): not applicable; Comparison (C): not applicable; Outcome (O): prevalence of MCI or the data can generate the prevalence of MCI according to study-defined criteria; Study design (S): cohort studies (only baseline data were extracted) and cross-sectional studies with accessible data published in a peer-reviewed journal. Studies involving mixed resources, reviews, systematic reviews, meta-analyses, case studies, and commentaries were excluded. Data analyses were performed using Stata Version 15.0. Random effects model was used to synthesize the overall prevalence of MCI. An 8-item instrument for epidemiological studies was used to assess the quality of included studies. A total of 53 articles were included involving 376,039 participants with a mean age ranging from 64.42 to 86.90 years from 17 countries. The pooled prevalence of MCI in older adults in nursing homes was 21.2% (95% CI: 18.7-23.6%). Subgroup and meta-regression analyses revealed that the screening tools used were significantly associated with MCI prevalence. Studies using the Montreal Cognitive Assessment (49.8%) had a higher prevalence of MCI than those using other instruments. No significant publication bias was found. Several limitations warrant attention in this study; for example, significant heterogeneity between studies remained and some factors associated with the prevalence of MCI were not examined due to insufficient data. Adequate screening measures and allocation of resources are needed to address the high global prevalence of MCI among older adults living in nursing homes.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Qinge Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.,Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Gabor S Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China. .,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.
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13
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St Clair B, Jorgensen M, Nguyen A, Georgiou A. A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges. Gerontol Geriatr Med 2022; 8:23337214221144192. [PMID: 36568485 PMCID: PMC9772958 DOI: 10.1177/23337214221144192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies (n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries (n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country's aged care system (n = 26, 56%). Only five studies (11%) included residents' voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.
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Affiliation(s)
- B. St Clair
- Macquarie University, Sydney, NSW, Australia,B. St Clair, Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.
| | | | - A. Nguyen
- Macquarie University, Sydney, NSW, Australia,UNSW Sydney, NSW, Australia
| | - A. Georgiou
- Macquarie University, Sydney, NSW, Australia
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14
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Yan E, Lai DWL, Cheng S, Kwok T, Leung EMF, Lou VWQ, Fong D, Chaudhury H, Pillemer K, Lachs M. Resident‐to‐resident
aggression in long‐term care facilities: Prevalence and risk factors. J Am Geriatr Soc 2022; 71:1666-1670. [PMID: 36519730 DOI: 10.1111/jgs.18175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences The Hong Kong Polytechnic University Hong Kong SAR China
| | - Daniel W. L. Lai
- Facuty of Social Sciences Hong Kong Baptist University Hong Kong SAR China
| | - Sheung‐Tak Cheng
- Department of Health and Physical Education The Education University of Hong Kong Hong Kong SAR China
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public Health The Chinese University of Hong Kong Hong Kong SAR China
| | | | - Vivian W. Q. Lou
- Department of Social Work and Social Administration University of Hong Kong Hong Kong SAR China
| | - Daniel Fong
- School of Nursing University of Hong Kong Hong Kong SAR China
| | - Habib Chaudhury
- Department of Gerontology Simon Fraser University Burnaby Canada
| | - Karl Pillemer
- Cornell College of Human Ecology Cornell University, Ithaca New York USA
| | - Mark Lachs
- Weill Cornell Medicine Cornell University, Ithaca New York USA
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15
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Conceptualizing violence in nursing home policy: A citizenship perspective. J Aging Stud 2022; 63:101064. [DOI: 10.1016/j.jaging.2022.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/21/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022]
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16
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Rosen T, Elman A, Clark S, Gogia K, Stern ME, Mulcare MR, Makaroun LK, Gottesman E, Baek D, Pearman M, Sullivan M, Brissenden K, Shaw A, Bloemen EM, LoFaso VM, Breckman R, Pillemer K, Sharma R, Lachs MS. Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program. J Am Geriatr Soc 2022; 70:3260-3272. [PMID: 35860986 PMCID: PMC9669128 DOI: 10.1111/jgs.17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED-based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. METHODS We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. RESULTS During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty-two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy-five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety-four percent reported believing that there is merit in establishing a VEPT Program in other EDs. CONCLUSION VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer-term outcomes.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine / Boston Medical Center, Boston, MA, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mary R. Mulcare
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Lena K. Makaroun
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Morgan Pearman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kelly Brissenden
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elizabeth M. Bloemen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
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17
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Pillemer K, Silver S, Ramirez M, Kong J, Eimicke JP, Boratgis GD, Meador R, Schultz L, Lachs MS, Nolte J, Chen EK, Teresi JA. Factors associated with resident-to-resident elder mistreatment in nursing homes. J Am Geriatr Soc 2021; 70:1208-1217. [PMID: 34958677 DOI: 10.1111/jgs.17622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resident-to-resident elder mistreatment (RREM) in nursing homes has serious physical and psychological consequences, but factors related to RREM occurrence remain unclear. This study identifies individual and environmental characteristics associated with involvement in RREM episodes. METHODS The design was an observational study carried out in five urban and five suburban New York state nursing homes randomly selected on the basis of size and location. The sample consisted of 2011 residents in 10 facilities; 83% of facilities and 84% of eligible residents participated. RREM and potential correlates were identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports. RESULTS A multivariate analysis controlling for relevant covariates found that individuals involved in RREM incidents exhibit milder dementia, show behavioral symptoms, and are less functionally impaired. Although special care units (SCU) for dementia have benefits for residents, one potential hazard for SCU residents is elevated risk for RREM. CONCLUSIONS Interventions to prevent and intervene in RREM incidents are greatly needed. The correlates identified in this research point to the need for targeted interventions, specifically for residents with milder impairment and with behavioral symptoms and individuals in SCUs.
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Affiliation(s)
- Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA.,Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Stephanie Silver
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Mildred Ramirez
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA.,Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Jian Kong
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Gabriel D Boratgis
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Rhoda Meador
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Leslie Schultz
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Mark S Lachs
- Division of Geriatric Medicine and Gerontology, Weill Cornell Medical College, New York, New York, USA
| | - Julia Nolte
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - Emily K Chen
- Rand Corporation, Washington, District of Columbia, USA
| | - Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA.,Columbia University Stroud Center, New York State Psychiatric Institute, New York, New York, USA
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18
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Smith DE, Wright MT, Ibrahim JE. Aged care nurses' perception of unwanted sexual behaviour in Australian residential aged care services. Australas J Ageing 2021; 41:153-159. [PMID: 34792228 DOI: 10.1111/ajag.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore aged care nurses' awareness and experience of unwanted sexual behaviour (USB) in residential aged care services (RACS). METHODS An anonymous online questionnaire was administered to an opportunistic sample of RACS nurses enrolled to complete an e-learning course in Australia. From the 167 participants who expressed interest to enrol, 129 were eligible and 53 returned completed consent forms. RESULTS 46/53 responded of which most were females (41/45, 91.1%). Few respondents reported resident-resident USB (<35%) or staff-resident USB (<22%) happened once a year. Most respondents had not been informed by a resident of USB (>75%) or had personally reported USB within their internal reporting system (>77%). Respondents were also unaware if their facility had lodged an incident report to the regulator or law enforcement authorities within the past 12 months (34/46, 73.9%). Finally, most considered there to be no barriers to reporting USB (35/46, 77.8%). CONCLUSIONS Respondents' awareness and estimates of USB directed at residents were much lower than known national prevalence rates. This lack of awareness could be a substantive barrier to recognition and optimal management of this form of abuse.
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Affiliation(s)
- Daisy E Smith
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Meghan T Wright
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Joseph E Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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19
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Maltraitance entre résidents en temps de pandémie: Effets dans les résidences privées pour aînés au Québec. Can J Aging 2021. [DOI: 10.1017/s0714980821000428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractThe measures implemented to limit the spread of COVID-19 affect the social relationships of the elderly. The aim of this article is to understand the effects of the pandemic on residents and resident-to-resident aggression (RRA). In total, 21 individual interviews were conducted with three groups of actors of four independent living facilities who have experienced RRA (residents) or who intervene in this type of situation (members of staff and external stakeholders). The participants reported that the pandemic has effects on residents and, specifically, on RRA. Among other things, the management and resolution of these situations have changed, and new manifestations of RRA are observed. To our knowledge, this study is the first to examine the effects of the pandemic on residents living in independent living facilities and on RRA. It raises the need to further consider residents’ voices in this context and to combine them with those of other actors to better understand how RRA manifest itself.
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20
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St Clair B, Jorgensen M, Georgiou A. Incidence of adverse incidents in residential aged care. AUST HEALTH REV 2021; 46:405-413. [PMID: 34662271 DOI: 10.1071/ah21090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveAdverse incident research within residential aged care facilities (RACFs) is increasing and there is growing awareness of safety and quality issues. However, large-scale evidence identifying specific areas of need and at-risk residents is lacking. This study used routinely collected incident management system data to quantify the types and rates of adverse incidents experienced by residents of RACFs.MethodsA concurrent mixed-methods design was used to examine 3 years of incident management report data from 72 RACFs in New South Wales and the Australian Capital Territory. Qualitative thematic analysis of free-text incident descriptions was undertaken to group adverse incidents into categories. The rates and types of adverse incidents based on these categories were calculated and then compared using incidence rate ratios (IRRs).ResultsDeidentified records of 11 987 permanent residents (aged ≥65 years; mean (±s.d.) age 84 ± 8 years) from the facilities were included. Of the 60 268 adverse incidents, falls were the most common event (36%), followed by behaviour-related events (33%), other impacts and injuries (22%) and medication errors (9%). The number of adverse incidents per resident ranged from 0 (42%) to 171, with a median of 2. Women (IRR 0.804; P < 0.001) and residents with low care needs (IRR 0.652; P < 0.001) were significantly less likely to adverse incidents compared with men and residents with high care needs respectively.ConclusionThis study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs.What is known about the topic?To date, research into aged care adverse incidents has typically focused on single incident types in small studies involving mitigation strategies. Little has been published quantifying the multiple adverse incidents experienced by residents of aged care facilities or reporting organisation-wide rates of adverse incidents.What does this paper add?This paper adds to the growing breadth of Australian aged care research by providing baseline information on the rates and types of adverse incidents in RACFs across a large and representative provider.What are the implications for practitioners?This research demonstrates that the wealth of data captured by aged care facilities' incident management information systems can be used to provide insight into areas of commonly occurring adverse incidents. Better use of this information could greatly enhance strategic planning of quality improvement activities and the care provided to residents.
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Affiliation(s)
- Bella St Clair
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Mikaela Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
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21
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Liu PJ, Caspi E, Cheng CW. Complaints Matter: Seriousness of Elder Mistreatment Citations in Nursing Homes Nationwide. J Appl Gerontol 2021; 41:908-917. [PMID: 34486438 DOI: 10.1177/07334648211043063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mistreatment of nursing home residents is prevalent and leads to harmful consequences. The Centers for Medicare & Medicaid Services's (CMS) mission to protect residents' right to be free from mistreatment is implemented partially through state survey agencies' (SSAs) issuance of deficiency citations. The goal of this study was to compare SSA standard surveys and SSA complaint investigations with regard to the seriousness (scope and severity) of the mistreatment citations issued. A cumulative link mixed model was built to estimate the differences between standard surveys and complaint investigations in the seriousness of four core and two secondary mistreatment citations nationwide from 2014 to 2017. In all of the six mistreatment deficiency citations, complaint investigations were more likely to be determined as more serious compared with standard surveys. The findings reinforce the importance of strengthening nursing homes' and CMS/SSA response to consumers' concerns and grievances before they escalate into more harmful mistreatment.
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Affiliation(s)
- Pi-Ju Liu
- Purdue University, West Lafayette, IN, USA
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22
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Chiong W, Tsou AY, Simmons Z, Bonnie RJ, Russell JA. Ethical Considerations in Dementia Diagnosis and Care: AAN Position Statement. Neurology 2021; 97:80-89. [PMID: 34524968 DOI: 10.1212/wnl.0000000000012079] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/08/2021] [Indexed: 11/15/2022] Open
Abstract
Alzheimer disease and other dementias present unique practical challenges for patients, their families, clinicians, and health systems. These challenges reflect not only the growing public health effect of dementia in an aging global population, but also more specific ethical complexities including early loss of patients' capacity to make decisions regarding their own care, the stigma often associated with a dementia diagnosis, the difficulty of balancing concern for patients' welfare with respect for patients' remaining independence, and the effect on the physical, emotional, and financial well-being of family caregivers. Caring for patients with dementia requires respecting patient autonomy while acknowledging progressively diminishing decisional capacity and continuing to provide care in accordance with other core ethical principles (beneficence, justice, and nonmaleficence). Whereas these ethical principles remain unchanged, neurologists must reconsider how to apply them given changes across multiple domains including our understanding of disease, clinical and legal tools for addressing manifestations of illness, our expanding awareness of the crucial role of family caregivers in providing care and maintaining patient quality of life, and societal conceptions of dementia and individuals' personal expectations for aging. This revision to the American Academy of Neurology's 1996 position statement summarizes ethical considerations that often arise in caring for patients with dementia; although it addresses how such considerations influence patient management, it is not a clinical practice guideline.
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Affiliation(s)
- Winston Chiong
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA.
| | - Amy Y Tsou
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
| | - Zachary Simmons
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
| | - Richard J Bonnie
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
| | - James A Russell
- From the Department of Neurology (W.C.), University of California San Francisco; Evidence-Based Practice Center (A.Y.T.), ECRI, Plymouth Meeting, PA; Division of Neurology (A.Y.T.), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia; Department of Neurology (Z.S.), The Pennsylvania State University, Hershey; School of Law (R.J.B.), University of Virginia, Charlottesville; and Department of Neurology (J.A.R.), Lahey Medical Center, Burlington, MA
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Saga S, Blekken LE, Nakrem S, Sandmoe A. Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study. BMC Health Serv Res 2021; 21:684. [PMID: 34247595 PMCID: PMC8272837 DOI: 10.1186/s12913-021-06713-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents’ ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives’ experiences with elder abuse in NH. Methods Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data. Results Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care. Conclusions Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.
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Affiliation(s)
- Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lene Elisabeth Blekken
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Sandmoe
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Cimino-Fiallos N, Rosen T. Elder Abuse-A Guide to Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am 2021; 39:405-417. [PMID: 33863468 DOI: 10.1016/j.emc.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Elder abuse affects many older adults and can be life threatening. Older adults both in the community and long-term care facilities are at risk. An emergency department visit is an opportunity for an abuse victim to seek help. Emergency clinicians should be able to recognize the signs of abuse, including patterns of injury consistent with mistreatment. Screening tools can assist clinicians in the diagnosis of abuse. Physicians can help victims of mistreatment by reporting the abuse to the appropriate investigative agency and by developing a treatment plan with a multidisciplinary team to include a safe discharge plan and close follow-up.
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Affiliation(s)
- Nicole Cimino-Fiallos
- Department of Emergency Medicine, Meritus Medical Center, 11116 Medical Campus Road, Hagerstown, MD 21742, USA.
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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Resident-to-Resident Elder Mistreatment in Residential Aged Care Services: A Systematic Review of Event Frequency, Type, Resident Characteristics, and History. J Am Med Dir Assoc 2021; 22:1678-1691.e6. [PMID: 33727003 DOI: 10.1016/j.jamda.2021.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/26/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Resident-to-resident elder mistreatment (R-REM) between residents living in residential aged care (RAC) services is a challenging issue in relation to the care of older people. Evidence suggests that R-REM, such as verbal, physical, and sexual conflict between residents, is a common and pervasive issue. This review examines the frequency with which R-REM occurs in RAC services; identifies the types of R-REM that occur; and provides an overview of the reported characteristics of both the victim and perpetrator involved in the R-REM event. DESIGN A systematic review was conducted. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Ageline, and Cochrane Library to identify qualitative and quantitative studies published in the English language. SETTING AND PARTICIPANTS Residents living in RAC services. MEASURES Data on frequency and characteristics were collated, and aggregate proportions were calculated where possible. RESULTS Twenty-six studies were identified; most (n = 20) were published in the United States. The overall proportion of residents engaged in R-REM was provided by 7 quantitative studies with the estimated frequency reported to be 12% to 23%. For qualitative studies, the number of care staff reporting to have observed R-REM ranged from 18.7% to 98.0%. Physical and verbal abuse were the most commonly reported types of mistreatment. Characteristics of the perpetrator of R-REM were reported in 12 (46.2%) studies. Overall, the mean age of perpetrators was 80.93 years, most were men (83.2%), and 64.4% had dementia and/or Alzheimer diagnosis. Characteristics of the victim and the history of R-REM were largely omitted from the published studies. CONCLUSION AND IMPLICATIONS The findings from the review broaden understanding on the extent of R-REM; the individual and event characteristics and ultimately support care planning, policy, and direction for future research. To improve understanding, quality of care, and RAC residents' well-being, further studies are recommended to address the identified gaps in knowledge.
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Ravyts SG, Perez E, Donovan EK, Soto P, Dzierzewski JM. Measurement of aggression in older adults. AGGRESSION AND VIOLENT BEHAVIOR 2021; 57:101484. [PMID: 34025202 PMCID: PMC8136141 DOI: 10.1016/j.avb.2020.101484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Aggressive behaviors are prevalent in late-life and are associated with important consequences for older adults, caregivers, and healthcare providers. Age-related changes in the manifestation of aggression are precipitated in part by the rise of cognitive impairment. Such changes necessitate the use of psychometrically sound measures. The present article identifies existing measures of aggression for older adults, highlights the strengths and limitations of these measures, and proposes avenues for future research in this area. Five full-scale measures of aggression, as well as five subscales of aggression embedded within larger non-aggression measures in older adults were identified. Overall, measures of aggression specific to late-life are predominately observational and limited to individuals with dementia or older adults living in long-term care settings. The psychometric properties of aggression scales in late-life generally indicate adequate internal consistency, interrater reliability, and concurrent validity. In contrast, the reliability and validity of subscales of aggression contained within larger neuropsychiatric measures are more difficult to ascertain due to limited research. Future investigations would benefit from examining the psychometric properties of widely-used self-report measures of aggression among older adults, further evaluating the psychometric properties of aggression subscales, and developing additional measures which are predictive of aggressive behaviors.
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Lachs M, Mosqueda L, Rosen T, Pillemer K. Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions. J Appl Gerontol 2021; 40:1437-1446. [PMID: 33586494 PMCID: PMC8362821 DOI: 10.1177/0733464821992182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist. Significant advances have been made in elder abuse research methodology, measurement, justice theory, and other relevant areas, which may remedy this gap. Particular advances include the use of elder abuse severity measures and goal attainment scaling, and the application of restorative justice theory to intervention. Elder abuse research also may benefit from advances in biomedical clinical trial methodology, including characterizing and following up with subjects excluded from trials or those who drop out, estimating numbers needed to treat to assess cost-effectiveness, and a priori stopping rules for when an intervention proves quickly beneficial or harmful. In this article, we argue these advances can and should inform elder abuse intervention research, propose a theoretical framework to guide such efforts, and demonstrate how this framework can inform practice, using elder abuse multidisciplinary teams and nursing home shelters as examples.
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Affiliation(s)
- Mark Lachs
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York City, USA
| | | | - Tony Rosen
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York City, USA
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28
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[Violent behavior of staff towards nursing home residents: A systematic review of instruments to measure prevalence]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 160:68-77. [PMID: 33483286 DOI: 10.1016/j.zefq.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/16/2020] [Accepted: 12/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reduction or prevention of violence is one of the fields of preventive interventions in nursing homes. To prove the effectiveness of appropriate interventions, valid instruments are crucial to measure violence. METHODS Between November 2019 and May 2020, a systematic search for studies and instruments was conducted in relevant databases and reference directories assessing violent behaviour by employees towards residents, by residents towards employees and resident-to-resident abuse. RESULTS 24 instruments were identified. 8 instruments capture staff-to-resident violence, 14 capture resident-to-staff violence, 3 resident-to-resident aggression, and 5 instruments are not exactly attributable to the constellation of violence. No instrument covers all three situations of violence. Four of the instruments used to capture violence by staff cover all forms of personal violence. Validity and reliability data are inadequate. DISCUSSION At present, there is no tool that fully depicts violence in resident homes and is suitable for measuring the effectiveness of interventions. There are sufficient tools for the individual constellations of violence that represent all forms of violence. Not all instruments could be procured in their original form, and even available instruments did not always provide information on the development of the instruments and a possible review of their quality. CONCLUSION There is a lack of an internationally comparable instrument representing elder abuse in the inpatient setting with sufficient validity and reliability.
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Herron RV, Funk LM, Spencer D. Stories of violence and dementia in mainstream news media: Applying a citizenship perspective. DEMENTIA 2020; 20:2077-2090. [PMID: 33337247 DOI: 10.1177/1471301220981232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we analyze how mainstream news media frames violence in relation to dementia and the consequences of different frames for people living with dementia and their carers. Conceptually, the goal is to bring literature on citizenship and aggression into dialog with each other. Empirically, a total of 141 regional and national English-language mainstream Canadian news media articles (2008-2019) with a focus on dementia, violence, and aggression were analyzed. Analytically, we examine how different actors are portrayed as victims or perpetrators; how their histories (identities, belonging, and exclusion) are told; how dementia is used to explain events; and what types of expert knowledge and authorities are introduced to make sense of stories of violence in relationships of care. Our analysis points to the implications of media narratives for people with dementia as well as carers and researchers seeking to address stigma and call for change.
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Affiliation(s)
- Rachel V Herron
- Department of Geography and Environment, 1916Brandon University, Canada
| | - Laura M Funk
- Department of Sociology and Criminology, 8664University of Manitoba, Canada
| | - Dale Spencer
- Department of Law and Legal Studies, 6339Carleton University, Canada
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Platts-Mills TF, Hurka-Richardson K, Shams RB, Aylward A, Dayaa JA, Manning M, Mosqueda L, Haukoos JS, Weaver MA, Sloane PD, Travers D, Hendry PL, Norse A, Jones CW, McLean SA, Reeve BB, Zimmerman S, Davenport K, Bynum D, Frederick E, Lassiter-Fisher K, Stuckey A, Daley-Placide R, Hoppens M, Betterton J, Owusu S, Flemming C, Colligan A. Multicenter Validation of an Emergency Department-Based Screening Tool to Identify Elder Abuse. Ann Emerg Med 2020; 76:280-290. [PMID: 32828327 DOI: 10.1016/j.annemergmed.2020.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/06/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse. METHODS We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool. RESULTS Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%). CONCLUSION This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rayad B Shams
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Aileen Aylward
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Joseph A Dayaa
- School of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jason S Haukoos
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO
| | - Mark A Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC
| | - Philip D Sloane
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Debbie Travers
- School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL
| | - Ashley Norse
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Sheryl Zimmerman
- University of North Carolina School of Social Work, Chapel Hill, NC
| | | | - Katie Davenport
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Debra Bynum
- Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Amy Stuckey
- University of North Carolina Healthcare, Chapel Hill, NC
| | | | - Mark Hoppens
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Judy Betterton
- University of North Carolina Healthcare, Chapel Hill, NC
| | - Samantha Owusu
- University of North Carolina Healthcare, Chapel Hill, NC
| | | | - Andrew Colligan
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
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Myhre J, Malmedal WK, Saga S, Ostaszkiewicz J, Nakrem S. Nursing home leaders' perception of factors influencing the reporting of elder abuse and neglect: a qualitative study. J Health Organ Manag 2020; ahead-of-print. [PMID: 32762219 DOI: 10.1108/jhom-02-2020-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice. DESIGN/METHODOLOGY/APPROACH A qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses. FINDINGS Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect. ORIGINALITY/VALUE This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.
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Affiliation(s)
- Janne Myhre
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Karin Malmedal
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Susan Saga
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, School of Nursing and Midwifery, Deakin University, Geelong, Australia
- National Ageing Research Institute Inc, Parkville, Australia
| | - Sigrid Nakrem
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Botngård A, Eide AH, Mosqueda L, Malmedal W. Resident-to-resident aggression in Norwegian nursing homes: a cross-sectional exploratory study. BMC Geriatr 2020; 20:222. [PMID: 32580701 PMCID: PMC7315524 DOI: 10.1186/s12877-020-01623-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background Resident-to-resident aggression in nursing homes is a public health problem of growing concern, impacting the safety, health and well-being of all residents involved. Despite this, little research has been conducted on its occurrence particularly in large-scale national studies. The aim of this study was to explore the extent and nature of resident-to-resident aggression in Norwegian nursing homes, as reported by nursing staff. Methods We conducted a cross-sectional exploratory study, where nursing staff in 100 randomly selected Norwegian nursing homes completed a pen and paper survey measuring how often they had observed incidents of resident-to-resident aggression during the past year. These rates were separated according to nursing home size, location and units of workplace. Results Of the 3693 nursing staff who participated (response rate 60.1%), 88.8% had observed one or more incidents of resident-to-resident aggression during the past year, with acts of verbal and physical aggression being the most commonly reported. Nursing staff working in dementia special care units, larger nursing homes and nursing homes located in suburban/urban municipalities, reported more incidents of resident-to-resident aggression than staff in short-term and long-term units, small institutions, and nursing homes located in rural municipalities. Conclusions This is the first national study of resident-to-resident aggression in Norwegian nursing homes and is one of the largest surveys worldwide exploring the extent and nature of resident-to-resident aggression in long-term care settings. Overall, we found a high occurrence of all types of aggression, suggesting a need for strategies to improve residents’ safety and quality of life in nursing homes.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Aggression and Older Adults: News Media Coverage across Care Settings and Relationships. Can J Aging 2020; 40:500-511. [PMID: 32517837 DOI: 10.1017/s0714980820000197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Systematic, in-depth exploration of news media coverage of aggression and older adults remains sparse, with little attention to how and why particular frames manifest in coverage across differing settings and relationships. Frame analysis was used to analyze 141 English-language Canadian news media articles published between 2008 and 2019. Existing coverage tended towards stigmatizing, fear-inducing, and biomedical framings of aggression, yet also reflected and reinforced ambiguity, most notably around key differences between settings and relations of care. Mainstream news coverage reflects tensions in public understandings of aggression and older adults (e.g., as a medical or criminal issue), reinforced in particular ways because of the nature of news reporting. More nuanced coverage would advance understanding of differences among settings, relationships, and types of actions, and of the need for multifaceted prevention and policy responses based on these differences.
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Myhre J, Saga S, Malmedal W, Ostaszkiewicz J, Nakrem S. Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders' perceptions of elder abuse and neglect. BMC Health Serv Res 2020; 20:199. [PMID: 32164695 PMCID: PMC7069163 DOI: 10.1186/s12913-020-5047-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The definition and understanding of elder abuse and neglect in nursing homes can vary in different jurisdictions as well as among health care staff, researchers, family members and residents themselves. Different understandings of what constitutes abuse and its severity make it difficult to compare findings in the literature on elder abuse in nursing homes and complicate identification, reporting, and managing the problem. Knowledge about nursing home leaders' perceptions of elder abuse and neglect is of particular interest since their understanding of the phenomenon will affect what they signal to staff as important to report and how they investigate adverse events to ensure residents' safety. The aim of the study was to explore nursing home leaders' perceptions of elder abuse and neglect. METHODS A qualitative exploratory study with six focus group interviews with 28 nursing home leaders in the role of care managers was conducted. Nursing home leaders' perceptions of different types of abuse within different situations were explored. The constant comparative method was used to analyse the data. RESULTS The results of this study indicate that elder abuse and neglect are an overlooked patient safety issue. Three analytical categories emerged from the analyses: 1) Abuse from co-residents: 'A normal part of nursing home life'; resident-to-resident aggression appeared to be so commonplace that care leaders perceived it as normal and had no strategy for handling it; 2) Abuse from relatives: 'A private affair'; relatives with abusive behaviour visiting nursing homes residents was described as difficult and something that should be kept between the resident and the relatives; 3) Abuse from direct-care staff: 'An unthinkable event'; staff-to-resident abuse was considered to be difficult to talk about and viewed as not being in accordance with the leaders' trust in their employees. CONCLUSIONS Findings in the present study show that care managers lack awareness of elder abuse and neglect, and that elder abuse is an overlooked patient safety issue. The consequence is that nursing home residents are at risk of being harmed and distressed. Care managers lack knowledge and strategies to identify and adequately manage abuse and neglect in nursing homes.
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Affiliation(s)
- Janne Myhre
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research- Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Australia
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia. J Women Aging 2020; 33:635-652. [PMID: 32142386 DOI: 10.1080/08952841.2020.1735925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly VanHaitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Liza Behrens
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Eshraghi
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
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Goergen T, Gerlach A, Nowak S, Reinelt-Ferber A, Jadzewski S, Taefi A. Danger in Safe Spaces? Resident-to-Resident Aggression in Institutional Care. INTERNATIONAL PERSPECTIVES ON AGING 2020. [DOI: 10.1007/978-3-030-25093-5_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Joyce CM. Prevalence and nature of resident-to-resident abuse incidents in Australian residential aged care. Australas J Ageing 2019; 39:269-276. [PMID: 31814276 PMCID: PMC7687084 DOI: 10.1111/ajag.12752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the prevalence of resident-to-resident abuse (RRA) in aged care facilities and to explore the nature, contributing factors and outcomes of abuse incidents. METHODS Retrospective cohort study of residents in 13 aged care facilities between 1 January and 31 December 2017, using data extracted from organisational incident reports. RESULTS A total of 169 RRA incidents were recorded, representing 0.56 incidents per 1000 bed days. 7.6% of residents were targets, and 6.9% exhibited aggression, in one or more RRA incidents over one year. In the majority of incidents (152, 89.9%), the aggressor had a cognitive impairment. Impacts on targets were mostly minor. The most common aggressor intervention was behaviour management (142; 84.0%). CONCLUSIONS Resident-to-resident abuse was found to be lower than in other reports. Typically, it involves residents with cognitive impairment and does not result in serious harm. Managing behavioural symptoms associated with cognitive impairment is critical in preventing and managing RRA.
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Affiliation(s)
- Catherine M Joyce
- Benetas, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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DeBois KA, Evans SD, Chatfield SL. Resident-to-Resident Aggression in Long-Term Care: Analysis of Structured and Unstructured Data From the National Violent Death Reporting System, 2003-2016. J Appl Gerontol 2019; 39:1069-1077. [DOI: 10.1177/0733464819863926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aging adults are at risk for multiple types of abuse including emotional, sexual, or physical abuse. Adults in skilled nursing or assisted living facilities might be particularly vulnerable to injury, including fatal injury resulting from incidents of resident-to-resident aggression (RRA). The purpose of this research is to report findings from the multistate National Violent Death Reporting System (NVDRS) related to fatal RRA incidents between years 2003 and 2016. We analyzed structured categorical data and unstructured narrative data on 101 identified fatal RRA incidents among individuals aged 65+. Findings included that victims average 16 years older than exhibitors and dementia diagnoses are present in most cases. Qualitative analysis revealed that events are described as both unexpected and preventable. Training to improve long-term care staff recognition and reporting of RRA events may potentially improve prevention and provide more accurate trend data. NVDRS data provide a useful source to follow trends in fatal RRA going forward.
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Grigorovich A, Kontos P, Kontos AP. The "Violent Resident": A Critical Exploration of the Ethics of Resident-to-Resident Aggression. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:173-183. [PMID: 30741393 DOI: 10.1007/s11673-019-09898-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
Resident-to-resident aggression is quite prevalent in long-term care settings. Within popular and empirical accounts, this form of aggression is most commonly attributed to the actions of an aberrant individual living with dementia characterized as the "violent resident." It is often a medical diagnosis of dementia that is highlighted as the ultimate cause of aggression. This neglects the fact that acts of aggression are influenced by broader structural conditions. This has ethical implications in that the emphasis on individual aberration informs public policy strategies for prevention with a focus on restricting the freedom of individuals using behavioural modification, drugs, or other restraints with the intent to protect others from harm. A more ethical approach requires attention to the structural conditions of long-term care that both foster aggression and constrain prevention efforts. To this end, we turn to a model of relational citizenship that offers a theory of embodied selfhood and relationality as essential to human dignity, thus entailing human rights protections. The application of an ethic based on this model offers a more holistic prevention strategy for resident-to-resident aggression by drawing attention to the critical need and obligation to promote human flourishing through system level efforts.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada.
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alexis P Kontos
- Department of Justice Canada, 284 Wellington Street, Ottawa, ON, K1A 0H8, Canada
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Problematizing Sexual Harassment in Residential Long-Term Care: The Need for a More Ethical Prevention Strategy. Can J Aging 2019; 39:117-127. [PMID: 30992088 DOI: 10.1017/s0714980819000199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
La promotion des droits sexuels dans les établissements de soins de longue durée est complexe sur le plan éthique, étant donné que ce milieu est à la fois une résidence et un lieu de travail. Bien que les données empiriques démontrent que le bien-être des soignants professionnels et des résidents sont inextricablement liés, les politiques publiques au Canada ne reconnaissent généralement pas cette relation et continuent de se concentrer isolément sur le bien-être des résidents ou des travailleurs. Les conséquences problématiques de cette situation sont particulièrement mises en évidence lorsque l'on considère les défis associés à la prévention du harcèlement sexuel envers les travailleurs, dans un contexte où l'on ne veut pas restreindre indûment la liberté d'expression sexuelle des résidents atteints de démence. Nous avons utilisé l'approche « Quel est le problème représenté ? » ("What's the Problem Represented to be?") de Carol Bacchi pour analyser de façon critique un plan d'action canadien récent visant à prévenir la violence et le harcèlement sexuels. Notre analyse suggère que cette approche de prévention du harcèlement sexuel n'est pas une politique publique prometteuse et pourrait même contribuer à augmenter le phénomène qu'elle vise à corriger. Il est donc urgent de concentrer les efforts de prévention sur les facteurs structurels de ce phénomène afin de soutenir les droits sexuels des soignants et des résidents. Supporting sexual rights in residential long-term care is ethically complex. The well-being of care workers and residents is inextricably linked, and increasingly recognized empirically, yet public policy in Canada generally continues to exclusively focus on either the well-being of residents or workers. The consequences of this are particularly evident when we consider how to prevent sexual harassment towards workers without unjustly restricting the freedom of sexual expression for residents living with dementia. Employing Carol Bacchi’s “What’s the Problem Represented to be?” approach, we critically analysed a recent Canadian action plan to prevent sexual violence and harassment. Our analysis suggests that this policy is less than promising and may reproduce the very phenomenon it is intended to redress. The need to refocus prevention efforts on the structural factors implicated in this phenomenon is urgent if we are to support the sexual rights of both care workers and residents.
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Calkins MP. From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia. THE GERONTOLOGIST 2018; 58:S114-S128. [PMID: 29361065 DOI: 10.1093/geront/gnx146] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/12/2022] Open
Abstract
The evidence about the role the designed and built environment plays in supporting individuals living with dementia has been steadily mounting for almost 40 years. Beginning with the work of M. Powell Lawton at the Weiss Pavilion at the Philadelphia Geriatric Center, there are now dozens of researchers who are exploring how the environment can be either supportive and therapeutic, indeed even serving as a prosthetic for various changes in cognition, or be a barrier to independent functioning and high quality of life. Two recent literature reviews published on the impact of environmental factors and characteristics on individuals living with dementia clearly delineate evidence that the environment can have a therapeutic or a debilitating impact on individuals living with dementia. Rather than duplicate these excellent reviews, this article puts the knowledge gleaned from this research into the shifting context that is long-term care. This article begins with an exploration of the evolution of approaches to the design of spaces for individuals living with dementia from traditional or medical models, to special care units (SCUs), to person-centered care (PCC), which is the organizing theme of this supplemental issue. A novel, person-centered way of conceptualizing the domains of environmental systems is then presented and used as the framework for structuring recommendations and creating supportive and therapeutic environments for individuals living with dementia. Although there are distinct pathophysiological and behavioral manifestations of different forms of dementia, there is almost no evidence that suggests alternative environmental characteristics are better for one type of dementia over another. Thus, this article will refer to "individuals living with dementia" as opposed to Alzheimer's disease or other specific forms of dementia. Further, this article only addresses residential environments: homes in the community, independent and assisted living residences and nursing homes. It does not address other settings, such as hospitals or hospice, or work and public community spaces, such as stores. It is recognized that individuals living with dementia do spend time in all these spaces, and fortunately, there is growing interest in creating more dementia-friendly communities, but they will not be addressed in this article. Most of the research that has been done has focused on shared residential settings, so that will be the primary focus on this article.
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Ellis JM, Ayala Quintanilla BP, Ward L, Campbell F. Implementation and evaluation of an education programme for nursing staff on recognising, reporting and managing resident-to-resident elder mistreatment in aged care facilities. J Adv Nurs 2018; 75:187-196. [DOI: 10.1111/jan.13819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Julie M. Ellis
- College of Science, Health and Engineering; School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - Beatriz Paulina Ayala Quintanilla
- College of Science, Health and Engineering; School of Nursing and Midwifery; The Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
- Mercy Hospital for Women; Heidelberg Vic. Australia
- Peruvian National Institute of Health; Jesus Maria Peru
| | - Louise Ward
- College of Science, Health and Engineering; School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - Fergus Campbell
- College of Science, Health and Engineering; School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
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Teresi JA, Ramírez M, Fulmer T, Ellis J, Silver S, Kong J, Eimicke JP, Boratgis G, Meador R, Lachs MS, Pillemer K. Resident-to-Resident Mistreatment: Evaluation of a Staff Training Program in the Reduction of Falls and Injuries. J Gerontol Nurs 2018; 44:15-23. [PMID: 29677382 PMCID: PMC6668910 DOI: 10.3928/00989134-20180326-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/22/2018] [Indexed: 11/20/2022]
Abstract
Resident-to-resident elder mistreatment (R-REM) occurs frequently in long-term services and support settings. The purpose of the current study was to evaluate the effect of a R-REM training program for nursing and other frontline staff on resident falls and injuries in a cluster randomized trial of units within four nursing homes. Interview and observational data from a sample of 1,201 residents (n = 600 and n = 601 in the usual care and intervention groups, respectively) and staff were collected at baseline and 6 and 12 months. A generalized linear model was used to model the falls/injuries outcome. The net reduction in falls and injuries was 5%, translating to 10 saved events per year in an averagesized facility. Although the result did not reach statistical significance due to low power, the findings of fall prevention associated with implementing the intervention in long-term care facilities is clinically important. [Journal of Gerontological Nursing, 44(6), 15-23.].
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Caspi E. The circumstances surrounding the death of 105 elders as a result of resident-to-resident incidents in dementia in long-term care homes. J Elder Abuse Negl 2018; 30:284-308. [DOI: 10.1080/08946566.2018.1474515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Eilon Caspi
- School of Nursing, Adult and Gerontological Health and Cooperative Unit, University of Minnesota, Minneapolis, MN, USA
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46
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Ellis JM, Ayala Quintanilla BP, Ward L, Campbell F, Hillel S, Downing C, Teresi J, Ramirez M. A systematic review protocol of educational programs for nursing staff on management of resident-to-resident elder mistreatment in residential aged care homes. J Adv Nurs 2018; 74:1975-1983. [PMID: 29732589 DOI: 10.1111/jan.13700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/01/2022]
Abstract
AIM To review evidence concerning educational programs for nursing staff on management of resident-to-resident elder mistreatment with the aim of preventing and reducing this abuse in residential aged care homes. BACKGROUND Although elder abuse has received considerable attention, very little is known regarding resident-to-resident elder mistreatment in residential aged care homes and about interventions/programs to prevent and reduce this harm. Nurses play an essential role in identifying and managing aggressive interactions. However, many nurses may not recognize these behaviours as forms of abuse. Thus, it is important to ascertain if educational programs for nursing staff have been developed and implemented. DESIGN Quantitative systematic review registered on PROSPERO (CRD42017080925). METHODS A systematic search of English published studies between 1980 - 2017 will be conducted in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo and Scopus. Risk of bias and quality of the studies will be evaluated by using the Cochrane Collaboration's tool and the Methodological Index for Nonrandomized studies. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data will be summarized by using a narrative description. This study was funded in January 2017. DISCUSSION Nursing staff should play a pivotal role in preventing and/or reducing resident-to-resident elder mistreatment. Therefore, it is important to identify available educational programs for nursing staff dealing with this abuse. Consequently, this review may provide evidence-based care for nursing staff to assist them in protecting older residents from experiencing abuse or being abused and in improving their well-being.
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Affiliation(s)
- Julie M Ellis
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
| | - Beatriz Paulina Ayala Quintanilla
- College of Science, Health and Engineering, School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
- Mercy Hospital for Women, Melbourne, Vic., Australia
- Peruvian National Institute of Health, Jesus Maria, Peru
| | - Louise Ward
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
| | - Fergus Campbell
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
| | - Stav Hillel
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
| | - Carolyn Downing
- Bundoora Extended Care Centre, Northern Health, Bundoora, Vic., Australia
| | - Jeanne Teresi
- Research Division, Hebrew Home at Riverdale, Riverdale, New York
- Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale, Riverdale, New York
- Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York
- Division of Geriatrics and Gerontology, Weill Cornell Medical College, New York, New York
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Makaroun LK, Taylor L, Rosen T. Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known. J Am Geriatr Soc 2018; 66:389-393. [PMID: 29124741 PMCID: PMC5809269 DOI: 10.1111/jgs.15170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At least 10% of older adults experience abuse, neglect, or exploitation annually in the United States, and this problem is expected to grow as our population ages. Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors. Veterans who receive their care through the Veterans Health Administration (VHA) have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment, and social isolation than the general population. As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults. The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served. This article outlines the rationale for developing a research agenda for elder abuse in the VHA, as well as potential first steps toward understanding more about this complex problem affecting veterans.
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Affiliation(s)
- Lena K. Makaroun
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA
| | - Laura Taylor
- National Director of Social Work, Veterans Health Administration, VA Central Office, Washington, D.C
| | - Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
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Jain B, Willoughby M, Winbolt M, Lo Giudice D, Ibrahim J. Stakeholder perceptions on resident-to-resident aggression: implications for prevention. AUST HEALTH REV 2018; 42:680-688. [DOI: 10.1071/ah17282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/08/2018] [Indexed: 11/23/2022]
Abstract
Objective Resident-to-resident aggression (RRA) in nursing homes is a matter of serious and profound concern, yet action to eliminate or mitigate RRA is hampered by a paucity of research. The aim of this study was to explore key stakeholders’ knowledge and perceptions of RRA in Australian nursing homes. Methods A qualitative cross-sectional study design was used, and semistructured telephone interviews were conducted. Participants were purposively and conveniently sampled with replacement from a range of aged care, healthcare and legal professional bodies, as well as advocacy organisations. The interview contained 12 closed-ended questions and six open-ended questions about participants’ knowledge, experiences, perceptions and attitudes to RRA. Participant characteristics and responses to closed-ended questions were aggregated and proportions calculated, and thematic analysis was conducted by two independent researchers using a directed content approach. Results Fifteen participants (11 females; 73.3%) in senior management positions were interviewed. All were familiar with the concept of RRA and just over half (n=8; 53.3%) had witnessed an incident. Major themes included the nature and causes of RRA and attitudes and responses to RRA. Potential causes of RRA included maladaptation to nursing home life, transfer of pre-existing issues into the nursing home environment, physical environment and staffing-related issues. RRA was commonly viewed by participants as dangerous and unpredictable or, conversely, as expected behaviour in a nursing home setting. A person-centred care approach was considered most effective for managing and responding to RRA. Conclusion The research demonstrates that understanding perceptions of RRA among key stakeholders is critical to identifying the nature and scope of the problem and to developing and implementing appropriate prevention strategies. What is known about the topic? RRA is common in nursing homes, with potentially fatal consequences for residents involved, and has serious implications for nursing home staff, managers, providers, and regulators. Despite this, the prevalence, impact, and prevention of RRA remains under-recognised and under-researched in Australia. What does this paper add? This is the first Australian study to produce qualitative findings on the knowledge and perceptions of RRA in nursing homes among key stakeholders. This paper reports on the knowledge and perceptions of individuals in senior management and policy roles in aged care and related fields in relation to four themes: nature; causes; attitudes; and responses to RRA. Our findings highlight the complex and multifactorial nature of RRA. What are the implications for practitioners? A movement towards person-centred care that promotes understanding of individual care needs is favoured as an approach to reducing RRA. Increased reporting of both minor and major incidents of RRA will help to identify patterns and inform appropriate responses. However, a cultural shift is first required to recognise RRA as a manageable and preventable health care and adult safeguarding issue.
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Murphy B, Bugeja L, Pilgrim J, Ibrahim JE. Deaths from Resident-to-Resident Aggression in Australian Nursing Homes. J Am Geriatr Soc 2017; 65:2603-2609. [DOI: 10.1111/jgs.15051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Briony Murphy
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Jennifer Pilgrim
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
| | - Joseph E. Ibrahim
- Department of Forensic Medicine; Monash University; Southbank Victoria Australia
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50
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Myers DR, Rogers RK, LeCrone HH, Kelley K. The Behavioral Health Role in Nursing Facility Social Work. J Appl Gerontol 2017; 38:1063-1095. [DOI: 10.1177/0733464817733103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Types of compromised resident behaviors licensed nursing facility social workers encounter, the behavioral health role they enact, and effective practices they apply have not been the subject of systematic investigation. Analyses of 20 in-depth interviews with Bachelor of Social Work (BSW)/Master of Social Work (MSW) social workers averaging 8.8 years of experience identified frequently occurring resident behaviors: physical and verbal aggression/disruption, passive disruption, socially and sexually inappropriateness. Six functions of the behavioral health role were care management, educating, investigating, preventing, mediating, and advocating. Skills most frequently applied were attention/affirmation/active listening, assessment, behavior management, building relationship, teamwork, and redirection. Narratives revealed role rewards as well as knowledge deficits, organizational barriers, personal maltreatment, and frustrations. Respondents offered perspectives and prescriptions for behavioral health practice in this setting. The findings expand understanding of the behavioral health role and provide an empirical basis for more research in this area. Recommendations, including educational competencies, are offered.
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