Improving Resident Relationships in Long-Term Care

The Cornell Chronicle reported an analysis of resident to resident aggression in assisted living facilities. The numbers are frightening.

One in six residents of assisted living facilities is subject to verbal, physical or other aggression by fellow residents in a typical month, and those suffering from dementia are most at risk, new research finds in the first large-scale study of the phenomenon. 

Over 800,000 people live in more than 30,600 assisted living facilities in the U.S., according to the American Health Care Association, numbers that are expected to grow with an aging population.

Interpersonal aggression is common in assisted living facilities and staff are inadequately trained to deal with it. Residents are vulnerable to psychological distress and physical injury from other residents, and that’s something we need to take very seriously.

-said Karl Pillemer, the Hazel E. Reed Professor of Psychology in Cornell’s College of Human Ecology (CHE) and professor of gerontology in medicine at Weill Cornell Medicine. Pillemer is the first author of “Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living,” published May 3 in JAMA Network Open.

The study found incidents of resident-to-resident aggression were nearly as prevalent as they are in nursing homes. That was unexpected, since assisted living residents should be less impaired, more mobile and have more privacy than those in nursing homes.

The results point to a need to train staff on how to recognize potentially harmful aggression and intervene, and for clearer policy guidance on how facilities should address the issue.

The researchers are currently testing a training program they developed, “Improving Resident Relationships in Long-Term Care,” which reduce injuries in nursing homes.

The study found that, as in nursing homes, the risk of interpersonal aggression was highest in memory care units serving residents with dementia, including Alzheimer’s disease – a prevalence of 22.5% compared to 10.3% in other units. Dementia may be associated with aggressive behaviors, the researchers said, and residents afflicted with it are concentrated in contained environments.

“In geriatrics, even minor incidents, physical or emotional, can get you into trouble,” researcher Mark Lachs said. “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.”