“That Myrtle woman…she’s sitting in my chair! That’s where I sit for lunch. Get up you stupid woman. Get out of my chair!!”
Many older adults who move into long term care communities are moving from a home where they either lived alone or with a spouse. Suddenly, they are put into a situation (usually not by their choosing) where they have to learn to live with people from varied backgrounds and cultures, and share communal spaces. This would be hard for anyone, but is especially difficult for older adults with dementia, who are now living with others who have dementia and the behavioral challenges that accompany it.
Resident-to-resident aggression (RRA) is the term used to describe the verbally, physically and sexually aggressive behaviors that occur between residents in long term care communities. It often takes place in dining rooms and other common areas where residents gather. Triggers for the aggression vary, but a qualitative study from 2008 (see link to full study below) found that RRA happens most commonly in the afternoons. This may be due to staff fatigue, shift change disruption, and resident fatigue and/or boredom. The study also noted that loneliness and a feeling of abandonment were other triggers for RRA, along with trying to gain control in a situation where residents feel they have lost it.
Managing resident-to-resident aggression is a challenge because of the variety of these possible triggers. While many residents benefit from consistent daily routines (for example, sitting in the same place for meals, like the person in our example above), this makes it difficult when flexibility is needed for unexpected situations (such as when Myrtle got dizzy and sat in another person’s usual chair to rest!)
Using DICE (Describe, Evaluate, Create & Evaluate—click on the link for tidbit on this: https://sites.psu.edu/eit4bpsd/2019/04/08/using-dice-to-assess-and-manage-challenging-behaviors/ ) can help determine the causes of some aggressive behaviors and would be a good first step towards discovering ways to prevent RRA in specific residents.
Possible interventions for RRA include removing an aggressive resident from the situation (especially if physical safety of others is at risk), redirecting or distracting the resident with an activity, asking residents to compromise if they are cognitively able to do so, and reminding the residents of community rules for common areas.
In long term care communities, just as in other group settings, it is necessary to balance the rights of individual residents with those of the larger community. Remind residents that living in a community requires tolerance and a willingness to support one another. One of our research interventionists says she encouraged the recreation staff at a community to work with the residents to develop group expectations and rules that all will follow during activities, thereby creating a friendly atmosphere and safe space where residents are expected to behave cordially.
Click on the link below to read the qualitative study referenced above on resident-to-resident aggression:
“The most important principle in treating the aggressive person is the effort to understand the meaning of the sequence that led to the aggressive behavior” – Prof. Jiska Cohen‐Mansfield
Have a great week!