• J Am Med Dir Assoc · Nov 2009

    Modifiable factors related to abusive behaviors in nursing home residents with dementia.

    • Ladislav Volicer, Jenny T Van der Steen, and Dinnus H M Frijters.
    • School of Aging Studies, University of South Florida, Tampa, FL, and Charles University 3rd Medical Faculty, Prague, Czech Republic. lvolicer@cas.usf.edu
    • J Am Med Dir Assoc. 2009 Nov 1; 10 (9): 617-22.

    ObjectivesTo determine modifiable factors related to abusive behaviors in nursing home residents with dementia.DesignAnalysis of Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI) information.SettingWe used MDS-RAI data from 8 Dutch nursing homes and 10 residential homes that volunteered to collect data for care planning. We included the data of residents within a 12-month time window for each facility separately, resulting in a range from April 4, 2007, to December 1, 2008.ParticipantsWe selected 929 residents older than 65 with Alzheimer's disease or other dementia who were dependent in decision making and not comatose.MeasurementsCognitive Performance Scale, MDS Depression Scale and several individual items from the MDS-RAI (ability to understand others, verbally and physically abusive behavioral symptoms, resist care, diagnosis of Alzheimer's disease and of dementia other than Alzheimer's disease, diagnosis of depression, presence of delusions, hallucinations, pain frequency and constipation, and number of days receiving medications).ResultsResistiveness to care, related to lack of understanding, depression, hallucinations and delusions, was strongly related to abusive behaviors. Presence of depressive symptoms and delusions was also related to abusive behaviors independent of resistiveness to care. Only very few residents who understood others and were not depressed were abusive.ConclusionAbusive behaviors may develop from lack of understanding leading to resistiveness to care. Behavioral interventions preventing escalation of resistiveness to care into combative behavior and the treatment of depression can be expected to decrease or prevent abusive behavior of most nursing home residents with dementia.

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