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

Fractionality in Homogeneity? Value differences and Cross-Cultural Conflict in Somalia

Despite the fact that intra-state conflict is a common feature of post-colonial African states, the seemingly endless nature of the Somali crisis has necessitated this study. The Somali case has proved immune to peace talks, military interventions, restructuring of governments by the international community, etc. The crisis had lingered, producing alarming figures of dead and displaced persons; a collapsed State, giving room for anarchy; unhindered militia presence on both land and sea; and persistently becoming a menace and threat to the peace of its immediate neighbours, the region and the world. All these visible manifestations of the Somali state can be regarded as convulsions of its internal value differences. Thus, this study seeks to examine the Somali value systems, the differences emanating from the jealous protection of such values, and how they have rendered conflict resolution attempts futile. With more emphasis on the structure of the Somali society, this study explores its unique stratifications that have kept the state collapsed. A descriptive-analytical approach is applied, while the data are basically collected from secondary sources. The findings of this research reveal the divisive characteristics of values which have manifested in segmentation, clannism, loyalty, among others. It has led to the endless violent struggle for dominance among the clans and social classes culminating in a total collapse of the state. It is therefore concluded that value differences have been detrimental to the peace of Somalia. This study recommends, among others, that genuine resolution efforts should thoroughly consider and engage these value differences. Keywords: clannism, conflict, loyalty, values, value differences