Aggressive Behaviors Among Nursing Home Residents: Association With Dementia and Behavioral Health Disorders

TitleAggressive Behaviors Among Nursing Home Residents: Association With Dementia and Behavioral Health Disorders
Publication TypeJournal Article
Year of Publication2018
AuthorsCen X., Li Y., Hasselberg M., Caprio T., Conwell Y., Temkin-Greener H.
JournalJ Am Med Dir Assoc
Volume19
Issue12
Pagination1104-1109.e4
Date PublishedDec
ISBN Number1525-8610
Accession Number30409493
KeywordsAggressive behavior, dementia, Mental illness, nursing home residents
Abstract

OBJECTIVES: We measured the prevalence and severity of aggressive behaviors (ABs) among nursing home (NH) residents and examined whether individuals with behavioral health disorders were more likely to exhibit aggressive behaviors than others. SETTING AND PARTICIPANTS: The analytical sample included 3,270,713 first Minimum Data Set (MDS) assessments for residents in 15,706 NHs in 2015. MEASURES: Individuals were identified as having (1) behavioral health disorders only (hierarchically categorized as schizophrenia/psychosis, bipolar disorder, personality disorder, substance abuse, depression/anxiety); (2) dementia only; (3) behavioral health disorders and dementia; or (4) neither. The Aggressive Behavior Scale (ABS) measured the degree of aggressive behaviors exhibited, based on 4 MDS items (verbal, physical, other behavioral symptoms, and rejection of care). The ABS scores ranged from 0 to 12 reflecting symptom severity as none (ABS score = 0), mild (ABS score = 1-2), moderate (ABS score = 3-5), and severe (ABS score = 6-12). Bivariate comparisons and multinomial logistic regressions were performed. RESULTS: Residents with behavioral health disorders and dementia had the highest prevalence of ABs (23.1%), followed by dementia only (15.3%), behavioral health disorders only (9.3%), and neither (5.3%). After controlling for individual risk factors and facility covariates, the relative risk of exhibiting severe ABs was 2.47, 5.50, and 9.42 for residents with behavioral health disorders only, dementia only, and behavioral health disorders and dementia, respectively, with a similar pattern for moderate or mild ABs. CONCLUSIONS: Residents with behavioral health disorders were less likely than residents with dementia to exhibit aggressive behaviors in nursing homes. Thus, anecdotally reported concerns that aggressive behaviors are primarily an issue for residents with behavioral health disorders, rather than those with dementia, were not empirically justified.

URLhttps://www.ncbi.nlm.nih.gov/pubmed/30409493
DOI10.1016/j.jamda.2018.09.010
Alternate JournalJournal of the American Medical Directors Association