In an article published in the Journal of Bioethical Inquiry, Alisa Grigorovich, PhD, from the Toronto Rehabilitation Institute-University Health Network, Ontario, Canada, and colleagues discussed the issue of resident-to-resident aggression (RRA) among persons living with dementia in long-term care settings.
The authors noted that persons living with dementia are among the most stigmatized groups in society. Individuals with dementia are often depicted as subject to unpredictable rage, with the dementia itself characterized as the ultimate cause of aggression.
Although violence against residents and providers does occur in residential care facilities, with a recent survey indicating that 7.6% of older adults had engaged in physical aggression or abuse toward other residents or providers, and that 9.5% had engaged in verbal aggression, the authors suggested that the cause of such aggression may be more structural than medical.
The authors questioned whether the source of RRA results from the dementia disease process and noted that individuals who exhibit RRA tend to be individuals with a prior history of aggression and less cognitive and functional impairment than the overall nursing home population. They noted that potential triggers include communal settings with the potential for roommate conflict, difficulties in communication, pain, hunger, loneliness, excessive environmental noise, boredom, and invasion of personal space.
Common approaches to managing RRA usually involve a combination of pharmacologic treatments and nonpharmacologic interventions such as addressing environmental triggers and training staff to identify and reduce triggers and to defuse aggressive situations; however, the authors maintained these approaches leave structural triggers unaddressed.
The authors argued that improving provider workloads and engaging “gerontologists, practising ethicists, policymakers, and health practitioners” who are committed to guaranteeing a “decent and dignified human life” for persons with dementia is required to help prevent RRA. At the same time, they called for implementation of sociocultural and political structures that support human flourishing, such as the provision of diverse creative outlets for residents and home-like architectural design of indoor and outdoor spaces.
Grigorovich A, Kontos P, Kontos, AP. The “violent resident”: a critical exploration of the ethics of resident-to-resident aggression [published online February 11, 2019]. J Bioeth Inq. doi: 10.1007/s11673-019-09898-1