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

"Feeling tranquil": the experience of rest among the caregivers’ of relatives with advanced dementia

Objetivo: Comprender la experiencia de descanso de las cuidadoras. Método: Estudio cualitativo guiado por los procedimientos de la teoría fundamentada que forma parte de otro más amplio sobre el alivio del peso del cuidado en situaciones de vulnerabilidad. En el estudio participaron 17 cuidadoras de familiares con demencia avanzada que fueron seleccionas con propósito. Los datos se recolectaron por medio de 17 entrevistas semi estructuradas. El análisis de datos se hizo basado en los procedimientos de la teoría fundamentada. Resultados: Las cuidadoras no descansan como antes lo hacían, el descanso de ahora es incompleto y depende del bienestar del familiar enfermo. La tranquilidad emerge en el estudio como el elemento central de esta nueva experiencia de descanso. Descansar ahora es una experiencia interpretada y que conlleva un trabajo de organización y emocional. Las cuidadoras crean, y pactan condiciones que les proporcione tranquilidad para poder descansar. Conclusiones: El presente estudio profundiza en la experiencia de aliviar del peso del cuidado y destaca la connotación moral presente en el cuidado familiar. Conocer como descansan las cuidadoras y que es lo que subjetivamente les proporciona descanso, no sólo contribuirá a que los profesionales de la salud lo promuevan y apoyen, sino también evitará culpabilizarlas por no querer o poder descansar. Los servicios de apoyo han de considerara el cambio que ha tenido para las cuidadoras la experiencia del descanso en sus vidas.Objective. To understand caregiver’s experience of rest. Method. Qualitative study guided by grounded theory procedures and part of a wider study about burden relief in vulnerable situations. 17 women family caregivers of patients with advanced dementia were purposely sampled. Data was collected with 17 semi structured interviews and analyzed following grounded theory procedures. Findings. Caregivers do not rest as before, now rest is incomplete and depend on the well being of their sick relative. Tranquillity emerged in the study as the central element of this new experience of rest. To rest now is an interpreted experience that implies an organizational and emotional work. Caregivers create and negotiate conditions that will provide the tranquillity to be able to rest. Conclusion. The present study deepens in the experience of relief of the burden of care and highlights the moral connotation present in family care. To know how caregivers rest and what subjectively gives them rest, will not only contribute to health care professionals to support and promoted it, but also will avoid to blame them for not being able or wanting to rest. The meaning of what is rest has changed as the lives of caregivers, Support services ought to consider the change that the experience of relief has taken place in caregivers lives.Financiación total del Fondo de Investigación en Salud, Programa de Promoción de la Investigación Biomédica y en Ciencias de la Salud, Ministerio de Sanidad y Consumo, PI060005