Nov. 10, 2014

Elder-to-elder abuse is common in nursing homes

After nationwide concern about elder abuse by family members – and by nursing home staffers suspected of harming residents – a Cornell University-Weill Cornell Medical College study finds a high level of resident-to-resident elder mistreatment.

Nearly one in five nursing home residents in 10 facilities across New York state were involved in at least one aggressive encounter with fellow residents during the four weeks previous to the study.

“These altercations are widespread and common in everyday nursing home life,” said Karl Pillemer, the Hazel E. Reed Professor in the College of Human Ecology’s Department of Human Development who also serves on the Weill Cornell faculty. “Despite the acute urgency of the problem, resident-to-resident mistreatment is underreported. Increased awareness and the adoption of effective interventions are greatly needed.”

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Nursing homes provide care for about 1.5 million frail older Americans. It may come as a surprise that violence and verbal aggression are also a part of nursing home life.

Inappropriate, disruptive or hostile behavior among nursing home residents is a sizable (19.8 percent) and growing problem, according to the new Cornell research.

Specific types of mistreatment include verbal incidents, such as cursing, screaming or yelling at another person (16 percent); physical incidents, such as hitting, kicking or biting (5.7 percent); and sexual incidents, such as exposing one’s genitals, touching other residents or attempting to gain sexual favors (1.3 percent).

A fourth category, which involved 10.5 percent of people, included unwelcome entry into another resident’s room or going through another resident’s possessions.

“We urgently need strategies to address this underrecognized problem, which affects fully one-fifth of all residents, erodes their quality of life and is stressful for staff to manage,” said Lachs.

The epidemic of resident-to-resident hostile behavior was reported Nov. 8 at the 2014 Gerontological Society of America Annual Scientific Meeting in Washington, D.C., by Pillemer and his Weill Cornell colleague, Mark S. Lachs, M.D., professor of clinical medicine and medical director of the New York City Elder Abuse Center.

The researchers say theirs is “the first study to directly observe and interview residents to determine the prevalence and predictors of elder mistreatment between residents in nursing homes,” and involved more than 2,000 residents. Data sources included staff interviews and reports, direct observation and a research-based questionnaire taken by residents and staff.

The research also suggests that individuals who are most likely to be involved in a mistreatment incident are younger, less cognitively and physically impaired, and prone to disruptive behavior, compared to fellow residents. There was no significant difference between men and women. African-Americans were less likely to be involved than non-Latino white and Latino residents. (The investigators noted that the study did not distinguish victims from perpetrators of resident-to-resident elder mistreatment.)

People who typically engage in resident-on-resident abuse are somewhat cognitively disabled but physically capable of moving around the facility, Pillemer told the gerontology conference. “Often, their underlying dementia or mood disorder can manifest as verbally or physically aggressive behavior. It’s no surprise that these individuals are more likely to partake in arguments, shouting matches, and pushing and shoving, particularly in such close, crowded quarters.”

Collaborating on the study was Jeanne Teresi, M.D., of the Hebrew Home for the Aged at Riverdale, New York. The study was funded by grants from the National Institute on Aging, the New York State Department of Health and the National Institute of Justice.

Jeff Young is a writer in the Weill Cornell Medical College Office of Public Affairs.