Nearly Half Of Residents In Nova Scotia Nursing Homes Display Behavioural Problems

Main Category: Seniors / Aging
Article Date: 21 Mar 2008 - 2:00 PDT

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A new report from the Canadian Institute for Health Information (CIHI) reveals that 45% of residents living in a sample of Nova Scotia nursing homes displayed behavioural symptoms, including resistance to care, verbal abuse, socially inappropriate behaviour, wandering and physical abuse. Caring for Nursing Home Residents With Behavioural Symptoms: Information to Support a Quality Response examines the behaviours and related health conditions of 699 residents in five facilities between 2003 and 2007.

Two out of five (40%) nursing-home residents showed one or more of four behaviours considered to be aggressive. Resisting help with personal care or medications was the most common behaviour (30%) while physical abuse, such as hitting, scratching or sexually abusing others, was the least frequent (10%). Some residents were also verbally abusive (16%) or showed socially inappropriate behaviour, such as screaming or rummaging in others' belongings (14%).

"Many elderly people require the assistance and care provided by nursing homes. However, our data show that a considerable number of residents demonstrate behaviours that can be a source of distress to themselves, to other residents and to staff," says Jean-Marie Berthelot, Vice President, Programs, at CIHI. "As our population ages and more people will be living in this type of setting, it is important to understand what factors contribute to these behaviours."

Delirium strongly associated with potentially aggressive behaviours

Delirium, insomnia and signs of depression were the three most important factors associated with aggressive behaviours in the Nova Scotia homes studied. The report also suggested that residents who had lost their independence in basic activities of daily life, and those who had complex health conditions, were more likely to demonstrate aggressive behaviours.

Having more than one condition contributed to a resident's risk of displaying aggressive behaviours. For example, residents who suffered from both delirium and depression were more likely to display aggressive behaviours than residents suffering from just one of these conditions.

"This information is important because some of these underlying health conditions can be identified and successfully treated, which in turn may improve the behaviours," says Nancy White, CIHI's Manager of Home and Continuing Care.

One in five nursing-home residents wandered

Wandering, or moving around with no discernable purpose, is another commonly observed behaviour in nursing homes. Among residents who were mobile, 20% wandered. Residents who were relatively independent in moving around within the nursing home were more likely to wander than those who required assistance.

Those with moderate to severe cognitive problems were at the highest risk of wandering. Residents diagnosed with either Alzheimer's or other dementia showed a higher risk than those without these conditions. The report also found that women were more likely to wander than men.

"Wandering is a serious safety concern," says White. "Residents may be at risk of falling or losing their way, and may require special care planning to manage these risks."

Information supports a quality response

The clinical assessment instrument used to gather the data for this study, the Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) (Copyright interRAI, 1997, 1999. Modified by CIHI with permission from interRAI for Canadian use.), provides real-time feedback to care providers on health conditions and risks of individual residents. This information supports a quality response to the challenges of caring for residents with behavioural symptoms.

Health system managers may also use this information to support planning of future facilities and services for these and other at-risk populations.

"Overall," says Berthelot, "these findings are valuable for health care providers as a basis for enhancing the quality of life for those living in nursing homes not only in Nova Scotia, but across the country."

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

http://www.cihi.ca