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To the Editor: Dr Shinoda-Tagawa and colleagues¹ reported that among residents of nursing homes, those who sustained physical injuries were more likely to be cognitively impaired, exhibit symptoms of wandering, be verbally abusive, have socially inappropriate behavior, or to live on an Alzheimer disease unit. Although we appreciate these findings, we are concerned that the authors' use of "violent incidents" rather than "injury" in the title implies a perpetrator, and thus the possibility of "blaming the victim." Similarly, the authors attributed risk factors to individuals, rather than to aspects of the nursing home environment. This approach tends to isolate individuals as problematic² and lead to their stigmatization.³ By contrast, environmental interventions and protective pathways may be effective in addressing the underlying structural problems.⁴ Furthermore, profiling based on a minimum data set may have the unintended consequence of making placements more difficult for stigmatized residents even as the report cards attempt . . . [Full Text of this Article]

Barbara Herbert, MD; Ylisabyth S. Bradshaw, DO, MSc
Department of Family Medicine and Community Health
Tufts University School of Medicine
Waltham, Mass

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