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BOSTON, MA — February 17, 2004 — Nursing home residents with Alzheimer’s disease and related cognitive disorders may risk becoming victims of violence by other residents, according to a recent study at the Harvard School of Health. The typical injured resident has wandered unattended, engaged in verbal abuse such as screaming, threatening, or cursing, and exhibited inappropriate social behavior. Inappropriate social behavior ranges from making odd noises and rummaging through the belongings of others to throwing food and disrobing in public.
The researchers obtained data for the year 2000 from the Massachusetts Department of Public Health’s Complaint and Incident Reporting System and from Minimum Data Set assessment for Massachusetts nursing home residents. Out of 1,132 reports of resident–to–resident physical abuse, 294 concerned cases of serious physical harm: 39 fractures, 6 dislocations, 113 lacerations, 31 reddened skin areas, and 105 bruises or hematomas (large bruises or collections of blood under the skin). The study also considered a “control group,” a total of one thousand nine hundred and ninety four residents who were not injured by other residents.
Most of the injured residents had Alzheimer’s disease, brain injuries, or other disorders effecting thought processes. They had trouble understanding when they were in danger and had little idea of how to behave or to respond. They may have unknowingly encouraged attacks by walking into someone’s bedroom and invading their personal space, or eating from another resident’s plate. Other attacks appeared to be unprovoked. Statistically, those with mildly impaired thinking were five times more likely to be injured than those who were not impaired. The risk difference was eight times higher for those with moderate impairment, and 12 times higher for those with severe impairment.
Injured residents were wanderers. They were less likely to have bed rails in their rooms and more likely to be long–term nursing home residents. Although the median age of the injured residents was 81, there were several injuries among younger residents as compared to those in the control group. Men were almost twice as likely to be injured as women.
Residents in an Alzheimer’s disease unit were almost three times as likely to be injured as those living in other units of a nursing home. Attacks took place in residents’ rooms and in hallways, dining rooms, and other public areas.
The Harvard researchers made it clear that they do not place blame for physical abuse on the injured nursing home residents, who are really victims. Instead, they suggest that nursing home staff intervene to protect this group from harm. To do this, staff must receive better training about the needs and thinking of Alzheimer’s disease patients. The researchers also noted that overcrowding can lead to violent incidents and championed the use of Velcro nets or stop signs in the doorways of residents’ room to increase privacy.
Further studies should explore other ways to combat violence in nursing home, the researchers said. They would consider the benefits of group recreation and exercise programs as well as music therapy. Studies should also address questions about which nursing home residents commit violence. What are their characteristics? Is a small group responsible for most of the problems?
Dr. Gisele Wolf–Klein, director of geriatric education, research and training at Parker Jewish Institute for Health Care and Rehabilitation in New Hyde Park, New York commented that violence against Alzheimer’s patients occurs because many nursing homes are understaffed. Therefore, employees cannot provide individual attention to each resident, especially those who wander. In addition, patients with Alzheimer’s disease often do not have the ability to judge a situation (Newsday, February 4, 2004).
Other research supports Dr. Wolf–Klein’s views about a crisis in staffing at nursing homes. A series of reports for members of the U.S. House of Representatives revealed that many nursing homes do not have enough staff to meet the levels recommended by federal officials (3.45 nursing hours per patient daily) and nursing home experts (4 nursing hours per patient). Annual inspections also show that too many nursing homes do not even meet minimal legal staffing requirements (3.2 nursing hours in California, as an example).
Even if minimal legal staffing requirements are met, they may not be stringent enough to accommodate many nursing home residents, including those with increased needs such as Alzheimer’s patients. “Laws are written in such a way that patients receive about three hours of hands–on care by nurses or aides every day,” Dr. Wolf–Klein said. “The rest of the time, you are on your own.” A report from the federal Institute of Medicine (IOM) concurs: “Federal regulations governing nursing home staffing are over a decade old and do not reflect new knowledge on safe staffing levels” (Keeping Patients Safe: Transforming the Work Environment for Nurses, Institute of Medicine, November 2003). The agency recommends increasing staffing standards for nursing homes.
Alzheimer’s disease involves a breakdown of brain cells. It results in short–term memory loss, a sharp decrease in language and reasoning skills, and the inability to perform routine tasks. Although the disease progresses slowly, it is eventually fatal. At present, Alzheimer’s disease is not curable, although some FDA approved drugs may improve memory skills.
Alzheimer’s patients who are moderately affected by the disease may wander aimlessly and become anxious, suspicious, and agitated—behaviors that if unchecked, can endanger themselves and others, especially in crowded nursing homes. Severely affected patients lose the ability to speak and become completely dependent upon their caregivers (Fisher Center, Alzheimer’s Research Foundation).
About 4.5 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association, a nonprofit research, support, and advocacy group for patients and their families. The proportion of people with the disease doubles every five years beyond the age of 65.
For more information about Alzheimer’s disease, including diagnosis, treatment, and the latest research and clinical trials, see Medline Plus Health Information. The web site is sponsored by the National Library of Medicine and the National Institutes of Health.
At Brayton Purcell, we believe that nursing home residents deserve a safe, secure environment. These vulnerable people depend on the facility for food, shelter, and health care as well as for dignified, respectful treatment. If you or a loved one has been injured or neglected in a nursing home, please feel free to contact us to learn about your legal options. We are experienced in elder abuse and nursing home abuse cases, including those concerning pain management issues.
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