Abstract
Objectives
We measured the prevalence and severity of aggressive behaviors (ABs) among nursing
home (NH) residents and examined whether individuals with behavioral health disorders
were more likely to exhibit aggressive behaviors than others.
Setting and participants
The analytical sample included 3,270,713 first Minimum Data Set (MDS) assessments
for residents in 15,706 NHs in 2015.
Measures
Individuals were identified as having (1) behavioral health disorders only (hierarchically
categorized as schizophrenia/psychosis, bipolar disorder, personality disorder, substance
abuse, depression/anxiety); (2) dementia only; (3) behavioral health disorders and
dementia; or (4) neither. The Aggressive Behavior Scale (ABS) measured the degree
of aggressive behaviors exhibited, based on 4 MDS items (verbal, physical, other behavioral
symptoms, and rejection of care). The ABS scores ranged from 0 to 12 reflecting symptom
severity as none (ABS score = 0), mild (ABS score = 1–2), moderate (ABS score = 3–5),
and severe (ABS score = 6–12). Bivariate comparisons and multinomial logistic regressions
were performed.
Results
Residents with behavioral health disorders and dementia had the highest prevalence
of ABs (23.1%), followed by dementia only (15.3%), behavioral health disorders only
(9.3%), and neither (5.3%). After controlling for individual risk factors and facility
covariates, the relative risk of exhibiting severe ABs was 2.47, 5.50, and 9.42 for
residents with behavioral health disorders only, dementia only, and behavioral health
disorders and dementia, respectively, with a similar pattern for moderate or mild
ABs.
Conclusions
Residents with behavioral health disorders were less likely than residents with dementia
to exhibit aggressive behaviors in nursing homes. Thus, anecdotally reported concerns
that aggressive behaviors are primarily an issue for residents with behavioral health
disorders, rather than those with dementia, were not empirically justified.
Keywords
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Article info
Publication history
Published online: November 05, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
