Resident-to-Resident Violent Incidents in Nursing Homes
- Tomoko Shinoda-Tagawa, MD, MPH;
- Ralph Leonard, MD, MPH;
- Jean Pontikas;
- John E. McDonough, DrPH;
- Donna Allen;
- Paul I. Dreyer, PhD
- Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health (Drs Shinoda-Tagawa and McDonough) and Harvard Injury Control Research Center (Dr Shinoda-Tagawa), Boston, Mass; Department of Internal Medicine, Division of Geriatrics, Yale Medical School, New Haven, Conn (Dr Leonard); Division of Health Care Quality, Massachusetts Department of Public Health, Boston (Drs Shinoda-Tagawa and Dreyer and Mss Pontikas and Allen); and Health Care For All, Boston, Mass (Dr McDonough).
Abstract
Context Little is known about nursing home residents' injuries that are inflicted by other residents.
Objective To assess risk factors for violent injury to nursing home residents by other residents.
Design, Setting, and Subjects Case-control study using data from the Massachusetts Department of Public Health's Complaint and Incident Reporting System and from Minimum Data Set assessments for Massachusetts nursing home residents. Cases had an injury sustained from an incident with another nursing home resident between January 1, 2000, and December 31, 2000, which left visible evidence (ie, fracture, dislocation, bruise or hematoma, laceration, and reddened area) (median age, 81 years). Controls were randomly selected from all residents who had a Minimum Data Set assessment completed in 2000 (n = 101 429) and no injury report (median age, 83 years). A total of 1994 controls were included in the analyses.
Main Outcome Measures Injury type and risk of being injured by resident-to-resident aggressive physical behaviors based on the specific characteristics of the injured resident.
Results During the first incident, 294 residents sustained fractures (n = 39), dislocations (n = 6), bruises or hematomas (n = 105), lacerations (n = 113), and reddened areas (n = 31). Injured residents (cases) were more likely to be cognitively impaired, exhibit symptoms of wandering, be verbally abusive, and have socially inappropriate behavior than the controls. Residents who were classified as needing extensive assistance (adjusted odds ratio [AOR], 0.3; 95% confidence interval [CI], 0.2-0.6) and being severely dependent (AOR, 0.12; 95% CI, 0.05-0.27) had a significant reduction in being injured. Residents in an Alzheimer disease unit were almost 3 times as likely to be injured than those living in other units (AOR, 3.2; 95% CI, 1.4-7.5).
Conclusions Injured residents were more likely, perhaps unknowingly, to "put themselves in harm's way," be verbally aggressive, and be cognitively impaired. Interventions to prevent these incidents should focus on the behavior of the injured persons.
- KEYWORDS:
- nursing homes
- quality of health care
- violence
