A high prevalence of resident-to-resident aggression in assisted living communities points to a need for staff member training to recognize the causes of that aggression as well as clearer policy guidance to address it and prevent resident harm, according to the authors of a new study.
Researchers from Cornell University and Columbia University published the study in JAMA Network Open using data from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. The training, originally developed for nursing homes, reduced injuries in those settings.
The study involved 930 residents of 14 licensed assisted living communities in New York between 2018 and 2022. The investigators expected to find lower rates of resident-to-resident aggression in assisted living than in nursing homes due to the lower prevalence of cognitive impairment and the greater privacy and space afforded to residents. But the prevalence in assisted living was higher than they expected, they said.
The researchers found that incidents of resident-to-resident aggression were almost as prevalent in assisted living as in nursing homes. The assisted living study found that one in six residents was subject to verbal, physical or other aggressions by another resident in a typical month, whereas the nursing home study found that one in five residents had experienced aggressive interactions in the past 30 days.
The results of the assisted living study revealed a monthly prevalence of resident-to-resident aggression of 15.2%, with verbal aggression the most common type (11.2%), including screaming, trying to scare someone or boss the person around, or using racist language.
Physical aggression — such as hitting, kicking, grabbing, spitting or throwing things — affected 4.4% of study participants. Sexual aggression — sexual innuendos or actions, or touching in a sexual manner — affected 0.8% of respondents, whereas “other” behavior accounted for 7.5% of aggressive incidents.
As in nursing homes, the risk of interpersonal aggression was highest in assisted living memory care units, with a prevalence of 22.5% compared with 10.3% in non-memory care units. A major reason for the higher prevalence in memory care units stems from residents’ close proximity to other residents who are not inhibited and are at higher risk for aggressive interactions, according to the study.
The authors said that their results point to a need to train staff members on how to recognize potentially harmful aggression and intervene, as well as a need for clearer policy guidance on how assisted living providers should address the issue. The researchers also said that community staff members should identify the root causes of that aggression, such as pain, depression or medication imbalances.
“Interpersonal aggression is common in assisted living facilities, and staff are inadequately trained to deal with it,” Karl Pillemer, PhD, the lead author of the study and a professor of gerontology in medicine at Weill Cornell Medicine at Cornell University, said in a release. “Residents are vulnerable to psychological distress and physical injury from other residents, and that’s something we need to take very seriously.”
Policymakers should consider reviewing and expanding current regulations and protocols to include policies for preventing, reporting and treating resident-to-resident aggression to ensure the safety of the increasing number of assisted living residents, researchers stated.
Study co-investigator Mark Lachs, MD, the co-chief of geriatrics and palliative medicine at Weill Cornell Medicine, said that any interactions could have serious consequences for frail, vulnerable residents.
“You can’t weather physical or verbal insults the way you can when you’re younger, and they really do reduce the quality of life in these environments,” Laches said in the release.
