Context Little is known about nursing home residents' injuries that are inflicted
by other residents.
Objective To assess risk factors for violent injury to nursing home residents
by other residents.
Design, Setting, and Subjects Case-control study using data from the Massachusetts Department of Public
Health's Complaint and Incident Reporting System and from Minimum Data Set
assessments for Massachusetts nursing home residents. Cases had an injury
sustained from an incident with another nursing home resident between January
1, 2000, and December 31, 2000, which left visible evidence (ie, fracture,
dislocation, bruise or hematoma, laceration, and reddened area) (median age,
81 years). Controls were randomly selected from all residents who had a Minimum
Data Set assessment completed in 2000 (n = 101 429) and no injury report
(median age, 83 years). A total of 1994 controls were included in the analyses.
Main Outcome Measures Injury type and risk of being injured by resident-to-resident aggressive
physical behaviors based on the specific characteristics of the injured resident.
Results During the first incident, 294 residents sustained fractures (n = 39),
dislocations (n = 6), bruises or hematomas (n = 105), lacerations (n = 113),
and reddened areas (n = 31). Injured residents (cases) were more likely to
be cognitively impaired, exhibit symptoms of wandering, be verbally abusive,
and have socially inappropriate behavior than the controls. Residents who
were classified as needing extensive assistance (adjusted odds ratio [AOR],
0.3; 95% confidence interval [CI], 0.2-0.6) and being severely dependent (AOR,
0.12; 95% CI, 0.05-0.27) had a significant reduction in being injured. Residents
in an Alzheimer disease unit were almost 3 times as likely to be injured than
those living in other units (AOR, 3.2; 95% CI, 1.4-7.5).
Conclusions Injured residents were more likely, perhaps unknowingly, to "put themselves
in harm's way," be verbally aggressive, and be cognitively impaired. Interventions
to prevent these incidents should focus on the behavior of the injured persons.