The purpose of this study was to investigate violence and aggression committed by nursing home residents that is directed toward other residents, referred to here as resident-to-resident elder mistreatment (R-REM).
This is an epidemiological prevalent cohort study with one wave of data collection. The parent study was conducted in five urban and five suburban nursing homes (N= 1405 urban residents; 441 suburban residents). Resident-to-resident abuse information was derived from residents, staff, observations, Incident and Accident reports and chart reviews. A prevalence period of two weeks was used for reporting purposes; one week before and after the prevalence period was allowed for case adjudication purposes using a gold standard consensus classification. The following items described how each data source was collected:
- In the resident version, individual items relate to R-REM specific behaviors. For each behavior, residents are asked if the behavior ever occurred in the facility, if it occurred in the past year, and in the past two weeks. If it occurred in the past two weeks, the number of times this occurred, and how bothersome the most bothersome event was (not at all, a little, a lot) were recorded.
- R-REM Staff Interview: a list of all potential R-REM behaviors is provided (via a handout) and the number of distinct incidents involving these behaviors is requested.For each incident (up to five), the behaviors involved, and where (e.g., dining area, hallway, resident's room) and when (e.g., morning, noon meal, afternoon) it occurred is recorded. In addition, who started the incident and a description of other participant(s) (sex and relationship) is recorded.
- Behavior Sheets: these sheets were designed as prescription pads to be carried in the pockets of nursing staff. They were distributed at the module 3 training session; additional pads were available at the nursing station. Sheets could be torn off after documenting R-REM.
- Accident and Incident Reports has information such as: the date and time the incident was discovered; who discovered the incident; how the incident was discovered; a description of the resident or residents involved and any relevant information regarding their condition (medical, psychological, behavioral, etc.) noted prior to the discovery of the incident.
- Resident Chart Review: nursing, social service, and activities notes, as well as care planning conference reports (and any other relevant documentation) were reviewed for reports of occurrences of R-REM. In some instances the chart contained documentation of R-REM occurrences that do not reach the level of an accident/incident report. Residents' background data, health and mental health history, any history on behavioral disturbance was also collected.
Selection of Facilities: using the SPSS pseudo random number generator (Statistical Package for the Social Sciences, 1997) procedure, six urban nursing homes were selected from among the population of 21 nursing homes with 250 or more beds in two urban regions: Manhattan and the Bronx. The nursing homes were selected from among this list to represent equally the two boroughs. Facilities with severe survey deficiencies were excluded. Agreement to participate was obtained from five of the six facilities, yielding a facility response rate of 83 percent.
Exclusion/Inclusion criteria for urban resident sample: a sample of short-stay rehabilitation residents was included for the purpose of the linked federal studies. All long-stay residents except those on hospice care were invited to participate. For residents who were unable to complete the consent process (due to e.g., cognitive impairment, language barrier, health impairment),consent was sought by designated proxies (families or legal guardians). Residents unable to respond (due to language other than English or Spanish, or impairment) were excluded from resident level measures; chart review, staff informant, and observational measures were performed on those families provided proxy consent. Including all residents who did not participate regardless of the reason in denominator, the overall response rate was 80.2%.
Exclusion/Inclusion criteria for suburban resident sample: similar to the urban sample, all long-stay residents (except those receiving hospice care) and a sample of short-stay were invited to participate. For residents who were unable to complete the consent process(due to e.g., cognitive impairment, language barrier, health impairment),consent was sought by designated proxies (families or legal guardians). Residents unable to respond (due to language other than English or Spanish, or impairment) were excluded from resident level measures; chart review, staff informant, and observational measures were performed on those families provided proxy consent. Including all residents who did not participate regardless of the reason (e.g., refusals, family refusals. sick in hospital) in denominator, the overall response rate was 58.4%.
Nursing home residents in suburban and urban New York City
This data set contains 1075 variables and 1778 observations. The variables included:
- Characteristics of the environment
- Resident demographics
- Determination of whether incidents qualified as resident-to-resident elder across each of the six sources
- Most influential sources
- Resident capacity
- Type of equipment present in main public area
- Persons and number of person involved in incident
- Classification of incident
- Type of fall and assault
- Location of incident
- Incident outcome information
- Resident injury
- General background information, incident relation, and the event date
- Incident/Trigger indication
- Chart review indication, such as finding, chart section, and trigger date
- Incident description information
The facility response rate was 83%.
The urban resident sample response rate was 80.2%.
The suburban resident sample response rate was 58.4%.