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Ralph Leonard, MD, MPH; Mary E. Tinetti, MD; Heather G. Allore, PhD; Margaret A. Drickamer, MD

Arch Intern Med. 2006;166:1295-1300.

Background  Physical aggression by nursing home residents is a burden to residents and staff. The identification of modifiable correlates would facilitate developing preventive strategies. The objectives of the study were to determine potentially modifiable resident characteristics that are associated with physical aggression and to correlate these characteristics with verbal aggression.

Methods  This was a cross-sectional study of nursing home residents in 5 states who had at least 1 annual Minimum Data Set assessment completed during 2002. Case subjects were defined as nursing home residents 60 years and older with dementia who were reported to have been physically aggressive in the week before their assessment. Control subjects were all other residents 60 years and older with dementia. The main outcome measure was being physically aggressive during the past week.

Results  A total of 103 344 residents met study criteria, of whom 7120 (6.9%) had been physically aggressive in the week before their annual Minimum Data Set assessment. After adjustment for potential confounders, including age, sex, severity of cognitive impairment, and dependence in activities of daily living, physical aggression was associated with depressive symptoms (adjusted odds ratio [AOR], 3.3; 99% confidence interval [CI], 3.0-3.6), delusions (AOR, 2.0; 99% CI, 1.7-2.4), hallucinations (AOR, 1.4; 99% CI, 1.1-1.8), and constipation (AOR, 1.3; 99% CI, 1.2-1.5). Urinary tract infections, respiratory tract infections, fevers, reported pain, and participation in recreational activities were not significantly associated with physical aggression in multivariate analyses (P>.01 for all). Except for constipation, the correlates of verbal aggression were similar to those of physical aggression.

Conclusion  If the associations we have estimated are causal, then treatment of depression, delusions, hallucinations, and constipation may reduce physical aggression among nursing home residents.

Author Affiliations: CALM-MD, LLC, St Louis Park, Minn (Dr Leonard); and Geriatrics Division, Department of Internal Medicine, Yale Medical School, New Haven, Conn (Drs Tinetti, Allore, and Drickamer).

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