aggressive behavior in the elderly

Etiology

• Alzheimer's disease is the most common comorbidity
• risk factors among staff/caregiver victims include:
  • hurrying residents to complete ADLs
    • high workload
    • young age
    • higher staff anger scores
  • failing to understand that the behavior of the staff member must change, the demented resident's behavior will not
• resident to resident aggression

Epidemiology

• 25% of workplace violence occurs in a nursing home
• repetitive aggressive disruptive behavior occurs regularly in 43-85% of nursing facilities
• resident to resident aggression is common

Clinical manifestations

• repetitive demands
• verbal outbursts
• sexual advances
• physically aggressive acts
  • 75% occur during close staff-resident contact
  • 43% occur with dressing
  • 33% occur with transfers or turns
  • more severely demented patients may be more likely to commit physically aggressive acts without typical escalation of verbal outbursts
• aggression of residents toward nursing home staff
  • verbal aggression is most frequent (77%)
  • physical aggression (54%)
  • sexual aggression (7%).

Complications

• resident to resident aggression can have clinical, quality of life, regulatory & legal consequences

Management

• behavioral management training for staff
  • defining aggressive behavior
  • identifying reasons for aggressive behaviot
  • enhancing communication techniques
  • mentoring de-escalation approaches
• pharmacologic agent if behavioral management unsuccessful
  • risperidone has the most data to support its use

More general terms

• aggression
• geriatric disorder; disease of old age; geriatric syndrome

Additional terms

• psychosis, agitation & difficult behavior in the elderly