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Alzheimer's, Dementia & Mental Health
Violence by Dementia Patients in Nursing Home
Associated with Key Factors
Depression, delusions, hallucinations and
constipation linked to aggression
June 27, 2006 - About 88,000 (6.8 percent) of U.S.
nursing home residents are physically aggressive every week - hitting,
shoving, scratching or sexually abusing others. Depressive symptoms,
delusions, hallucinations and constipation are associated with this physical
aggression among nursing home residents with dementia, according to a
report in the June 26 issue of the Archives of Internal Medicine, one of
the JAMA/Archives journals.
This aggression can inflict physical and
psychological harm on staff and other residents, according to background
information in the article. Verbal aggression, when residents threaten,
scream or curse at others, also can cause difficulties.
Ralph Leonard, M.D., M.P.H., of CALM-MD, LLC, St.
Louis Park, Minn., and colleagues studied nursing home residents age 60
years and older with dementia who resided in one of five states:
California, New York, Ohio, Pennsylvania or Texas.
The authors used data from the participants'
Minimum Data Set (completed in 2002), a health assessment completed
regularly for all residents of nursing homes that receive federal funds.
The assessment contains information about the resident's medical
condition and functional status.
Of 103,344 residents (average age 84 years) who met
the criteria for the study, 7,120 (6.9 percent) had been physically
aggressive in the week before their assessment and 10.5 percent had been
verbally abusive.
After the researchers considered other factors that
may play a role in aggression, including age, sex and the level to which
residents were able to perform daily tasks on their own, they found that
symptoms of depression, delusions, hallucinations and constipation were
associated with physical aggression. With the exception of constipation,
the same factors also contributed to verbal aggression.
Previous studies have linked psychological
conditions to aggression, but this study was one of the first to examine
the effects of constipation, the authors write. "We chose to study
constipation a priori because it is common, modifiable and recognized by
clinicians to be a cause of many non-specific symptoms," the authors
write.
"It is not clear whether physical aggression may be
related to factors that predispose to constipation (e.g.,
anticholinergic medications such as tricyclic antidepressants), the
symptoms associated with constipation or interventions such as
suppositories that may elicit a defensive action by some residents."
"Physical or verbal aggression among nursing home
residents with cognitive impairment may be a major cause of distress
among staff and other residents injured by the aggressor, as well as to
the aggressor," they conclude.
"We found that aggressive behavior among residents
was associated with depression, delusions and hallucinations, and that
physical aggression was also associated with constipation. All of these
factors may be amenable to intervention and, in addition to reducing the
morbidity associated with these entities themselves, effective treatment
may reduce the risk of violence in nursing homes."
Editor's Note: This study was supported in
part by a grant from the National Institute on Aging (Dr. Leonard), the
Donald W. Reynolds Foundation (Dr. Drickamer) and a grant from the
Claude D. Pepper Older Americans Independence Center at Yale (which is
supported by the National Institute on Aging).
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