Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities

BACKGROUND: Verbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB) is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism. METHODS: The goals of this secondary analysis of a cross-sectional study are to determine the prevalence of verbal and physical aggressive behaviours and to identify associated factors among older adults in long-term care facilities in the Quebec City area (n = 2 332). RESULTS: The same percentage of older adults displayed physical aggressive behaviour (21.2%) or verbal aggressive behaviour (21.5%), whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical) were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia. CONCLUSION: Cognitive impairment severity is the most significant predisposing factor for aggressive behaviour among older adults in long-term care facilities in the Quebec City area. Physical and chemical restraints were also significantly associated with AB. Based on these results, we suggest that caregivers should provide care to older adults with AB using approaches such as the progressively lowered stress threshold model and reactance theory which stress the importance of paying attention to the severity of cognitive impairment and avoiding the use of chemical or physical restraints

Balances in the Atmosphere and Ocean: Implications for Forecasting and Reliability

Scale interactions between a variety of motions in the atmosphere and ocean have many theoretical and practical implications from predictability at the weather scales to reliability at the slow seasonal and climate scales. Two classes of wavy motions are prominent at the hydrostatic limit, for instance: the fast inertia-gravity waves and the slow Rossby waves. Although only Rossby waves are believed to be of direct meteorological significance, neglecting the fast oscillations may corrupt numerical integrations leading to unrealistic results and eventually to a complete model crash. Reliability of long seasonal and climate scales depends upon a proper representation of, at least, the statistics of the weather scale phenomena under given boundary conditions. The predictability of the weather scale phenomena, on the other hand, depends on the proper evolution of the system from a given initial condition. It has long been shown that a balance between stringent and permissive control of the high-frequency oscillations can allow improvements to weather forecasting. Behind these concepts are the ways by which Rossby waves can interact, horizontally and vertically, with high-frequency oscillations, or with other slow frequency oscillations and even with topography. Thus, in the present work we make a review of Rossby wave theory, considering its generation mechanisms and their interactions, including a brief discussion of some applications for the atmosphere