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Fighting in care homes prevalent

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Nurses in care homes receive little training or guidance in dealing with aggression and violence between care home residents, despite its prevalence, warn US study authors.

Very little research has so far looked at preventing or intervening in altercations between residents, with the media tending to focus on cases of mistreatment perpetrated by staff, warn the team from New York’s Cornell University.

Aggression between residents is ‘highly prevalent and has serious physical and mental health consequences’, they concluded after carrying out two studies.

In one, published in the journal Aggression and Violent Behaviour, the team recorded as many as 30 episodes
of resident-to-resident aggression during one eight-hour shift.

In a second study, involving focus groups with 96 care home staff, they noted that incidents were most likely to take place during the afternoon and in dining room settings.

‘Reactions to calling out or noise-making behaviour were the most commonly described trigger,’ the authors said in the Journal of the American Geriatrics Society.

‘Anyone who spends much time in a nursing home will observe arguments, threats and shouting matches among residents.

‘Staff have few solutions available to them and typical interventions in the nursing home may have negative consequences for aggressive residents, including the use of psychotropic medications or isolation,’ they added.

Rowena Smith, chairperson of the Community District Nurses Association and safe adult guardian adviser for Surrey PCT, said more research was needed.

‘This is not something that has been recognised as an issue,’ she said.

Ian Hulatt, mental health adviser for the RCN, added: ‘There may be underlying reasons that people are aggressive towards each other and that needs to be managed.’

Increasingly younger people with dementia, such as those with HIV dementia or alcohol-related dementia, were residents in care homes, he warned. They are physically fit but extremely disorientated, so could potentially put more frail residents at risk.

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