Residents in old-age homes who are injured by other residents have behavior patterns that may provoke injury-causing physical contact, whether unintentionally, unknowingly, or otherwise, according to an article in the February 4th issue of The Journal of the American Medical Association.

According to background information in the article, residents of old-age homes are a very vulnerable population because of physical disability and cognitive impairment. The authors cited data indicating that roughly 88,000 such residents in the United States had exhibited aggressive behavior in the week prior to their assessment with the Minimum Data Set. The Data Set is a comprehensive assessment that includes diagnoses and treatment/medication plans for home residents that must be completed by nurses at least every 3 months in facilities that receive U.S. federal funding.

Tomoko Shinoda-Tagawa, MD., MPH, led a study that assessed risk factors for violent injury to American old-age home residents by other residents. They used a state database to review 1,132 incident reports on injury to a resident by another resident during the calendar year 2000. The researchers randomly selected 1,994 residents from the same area who had no injury report filed during the same time period as a control group.

Of 294 residents included in the analysis, 39 sustained fractures, 6 had dislocations, 105 had bruises or hematomas, 113 had lacerations, and 31 had reddened skin areas, according to the researchers. Injured residents were more likely (than non-injured residents) to be cognitively impaired, exhibit wandering, be verbally abusive, and have socially inappropriate behaviors. Male residents were almost 2 times as likely to be injured as female residents. Residents in an Alzheimer disease unit were almost 3 times more likely to be injured than those living in other units. In contrast, residents who were classified as needing extensive assistance and being severely dependent were less likely to be injured.

"Our finding suggested that it is possible that some of the residents who sustained injuries may have provoked the attacks," the authors wrote. "Wandering was strongly associated with being injured, which suggests that some injured residents may get themselves in trouble by accidentally provoking an attack due to wandering into another residents' 'personal space.'"

The authors concluded, "Injured residents were more likely, perhaps unknowingly, to 'put themselves in harm's way,' be verbally aggressive, and be cognitively impaired. Intervention to prevent these incidents should focus on the behavior of the injured persons."