Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living.

Importance: Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective: To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants: This study used cross-sectional, observational data from a clinical trial, in which residents of assisted living facilities were monitored for events over a 1-month period. All residents of 14 large facilities randomly selected from 2 geographic locations (N = 1067), except those receiving hospice care (n = 11), were invited to participate; 93 died or moved prior to enrollment. There were 33 family and resident refusals; 930 residents were enrolled. Data were collected between May 30, 2018, and August 11, 2022. Main Outcomes and Measures: The data are from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. In addition, the study was designed to assess prevalence using the Time 1 (baseline) data, using a probability sample of facilities to allow for this analysis. Resident-to-resident aggression was identified using a mixed-method, case-finding strategy involving 6 sources: (1) cognitively capable resident reports regarding 22 possible events, (2) direct care staff report, (3) staff member reports collected from event-reporting forms, (4) research assistant observation of events in real time, (5) facility accident or incident reports, and (6) resident records. Results: The prevalence of resident-to-resident aggression among the 930 participants (mean [SD] age, 88.0 [7.2] years; 738 women [79.4%]) during the past month was estimated to be 15.2% (141 of 930 residents; 95% CI, 12.1%-18.8%). The most common forms of aggression included verbal (11.2% [104 of 930 residents; 95% CI, 8.8%-14.2%]), physical (41 of 930 residents; 4.4% [95% CI, 3.1%-6.3%]), sexual (0.8% [7 of 930 residents; 95% CI, 0.4%-1.6%]), and other (70 of 930 residents; 7.5% [95% CI, 5.5%-10.2%]). These categories are not mutually exclusive as residents could be involved with more than 1 type of aggressive behavior. Conclusions and Relevance: In this cross-sectional, observational prevalence study, resident-to-resident aggression in assisted living facilities was highly prevalent. Verbal aggression was the most common form, and physical aggression also occurred frequently. The effects of resident-to-resident aggression can be both morbid and mortal; therefore, intervention research is needed to prevent it and to treat it when it occurs.

Factors associated with resident-to-resident elder mistreatment in nursing homes.

BACKGROUND: Resident-to-resident elder mistreatment (RREM) in nursing homes has serious physical and psychological consequences, but factors related to RREM occurrence remain unclear. This study identifies individual and environmental characteristics associated with involvement in RREM episodes. METHODS: The design was an observational study carried out in five urban and five suburban New York state nursing homes randomly selected on the basis of size and location. The sample consisted of 2011 residents in 10 facilities; 83% of facilities and 84% of eligible residents participated. RREM and potential correlates were identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports. RESULTS: A multivariate analysis controlling for relevant covariates found that individuals involved in RREM incidents exhibit milder dementia, show behavioral symptoms, and are less functionally impaired. Although special care units (SCU) for dementia have benefits for residents, one potential hazard for SCU residents is elevated risk for RREM. CONCLUSIONS: Interventions to prevent and intervene in RREM incidents are greatly needed. The correlates identified in this research point to the need for targeted interventions, specifically for residents with milder impairment and with behavioral symptoms and individuals in SCUs.

Resident-to-resident elder mistreatment (R-REM) intervention for direct care staff in assisted living residences: study protocol for a cluster randomized controlled trial.

BACKGROUND: Resident-to-resident elder mistreatment (R-REM) is defined as negative and aggressive physical, sexual, or verbal interactions between (long-term care) residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological harm and distress. R-REM has been established as a serious problem that has a negative impact on the safety, physical well-being, and quality-of-life of residents living in nursing homes. Although there are no in-depth studies, there is evidence that it is prevalent in assisted living residences and associated with a variety of person, environmental, and facility characteristics. The authors conducted the first systematic, prospective study of resident-to-resident elder mistreatment in nursing homes and developed an intervention for direct care staff to enhance knowledge of R-REM and increase reporting and resident safety by reducing falls and associated injuries. The study aim was to examine the effects of this intervention in assisted living residences. The primary distal outcome is falls and injuries, and the key process outcomes are staff knowledge and reporting. METHODS: Twelve larger licensed assisted living residences with special care dementia units in two New York State regions will be enrolled on a rolling basis and randomized to intervention or usual care. Data derived from five sources, (1) resident interviews, (2) staff informants, (3) observational data, (4) chart, and (5) incident/accident report data, will be collected at baseline and 6 and 12 months with respect to 1050 residents (750 "downstate" and 300 "upstate"). The intervention is three training modules delivered on-site after baseline data collection for front line staff on all shifts in facilities randomized to the intervention. Modules relate to recognition, management, and reporting of resident-to-resident elder mistreatment. DISCUSSION: Given the movement toward alternative congregate living arrangements for older individuals with significant comorbidities, including cognitive impairment; it is critical to enhance resident safety measured by falls, accidents, and injuries and staff knowledge related to recognition, reporting, and treatment of resident-to-resident aggressive and related negative interactions in such settings. This project is important in developing approaches for ameliorating and preventing R-REM in assisted living residences and enhancing resident safety and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT03383289 . Registered on 26 December 2017.

Getting Along in Assisted Living: Quality of Relationships Between Family Members and Staff.

BACKGROUND AND OBJECTIVES: Assisted living facilities (ALFs) have quickly expanded as an alternative to nursing homes. Research on nursing homes has revealed problems in relationships between family members and staff. However, little is known about these relationships within ALFs. The purpose of the current study was to examine the prevalence of conflict and positive and negative interactions from the perspective of both family members and staff and to examine the effects of positive and negative aspects of the relationship on salient staff and family outcomes in ALFs. RESEARCH DESIGN AND METHODS: Data were collected from 252 family members and 472 staff members across 20 ALFs who participated in the Partners in Care in Assisted Living study. Participants completed measures including interpersonal conflict, depressive symptoms, perception of treatment, and stress related to caregiving. RESULTS: Conflict among family and staff members was found to be relatively low. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depressive symptoms. For families, only female gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative had dementia. DISCUSSION AND IMPLICATIONS: Despite the relatively harmonious relationships among family-staff in ALFs, sources of conflict and negative interactions were identified, revealing the importance of collaborative relationships and the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts to improve family-staff interactions within ALFs.

Resident-to-Resident Mistreatment: Evaluation of a Staff Training Program in the Reduction of Falls and Injuries.

Resident-to-resident elder mistreatment (R-REM) occurs frequently in long-term services and support settings. The purpose of the current study was to evaluate the effect of a R-REM training program for nursing and other frontline staff on resident falls and injuries in a cluster randomized trial of units within four nursing homes. Interview and observational data from a sample of 1,201 residents (n = 600 and n = 601 in the usual care and intervention groups, respectively) and staff were collected at baseline and 6 and 12 months. A generalized linear model was used to model the falls/injuries outcome. The net reduction in falls and injuries was 5%, translating to 10 saved events per year in an averagesized facility. Although the result did not reach statistical significance due to low power, the findings of fall prevention associated with implementing the intervention in long-term care facilities is clinically important. [Journal of Gerontological Nursing, 44(6), 15-23.].

Engaging Older Adults in Environmental Volunteerism: The Retirees in Service to the Environment Program.

Purpose of the Study: Retirees in Service to the Environment (RISE) is a program designed to promote participation of older people in volunteering for the environment. Based on principles of adult learning and best practices for the development of effective volunteer programs, RISE engaged older individuals in environmental volunteering and involved them in community stewardship activities. Design and Methods: This article details the development and formative evaluation of RISE. We describe program assessment, benefits to the community, and effects on participants. Results: The program successfully recruited individuals new to environmental volunteering and substantial hours of volunteer time were provided to communities. Program satisfaction was high and preliminary evidence suggests positive outcomes from RISE participation. Implications: The innovative structure combined with local relevance of the RISE program has the potential to expand older adults' engagement in environmental volunteerism.

Effects of electronic health information technology implementation on nursing home resident outcomes.

OBJECTIVE: To examine the effects of electronic health information technology (HIT) on nursing home residents. METHODS: The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. RESULTS: No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. DISCUSSION: The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior.

Going home: identifying and overcoming barriers to nursing home discharge.

This article describes barriers to nursing home discharge encountered in an intervention designed to transition nursing home residents to the community. Staff in the intervention ("Project Home") provided intensive case management and discharge planning services to nursing home residents who expressed a desire to return to community-based living arrangements. Sixty program participants took part in the program evaluation that informs this article. With the exception of Medicaid status, no differences were found between the social, demographic, and health characteristics of individuals who remained in the nursing home and those who were discharged. A qualitative analysis was conducted to describe barriers to discharge and strategies intervention staff used to leverage each client's strengths and work around obstacles. Three main barriers to discharge were found: having an unstable or complex medical condition, lacking family or social support, and being unable to obtain suitable housing. Intervention staff advocated on the behalf of clients, encouraged clients to build skills toward independent living. and contributed extensive knowledge of local resources to advance client goals. Cases of successful transition suggest that a person-centered approach from intervention staff combined with a flexible organizational structure is a promising model for future interventions.

Environmental sustainability in an aging society: a research agenda.

OBJECTIVE: This article presents the results of a multidisciplinary consensus conference held to recommend a research agenda on the relationship between aging and environmental sustainability and conservation. The intersection of these two topics has important implications for the health and well-being of older persons but it has thus far received little scientific attention. METHODS: The consensus conference was conducted with gerontological experts from various disciplines and environmental scientists. Using a structured methodology, participants achieved consensus on recommendations for a research agenda on aging and environmental sustainability. RESULTS: Eight major recommendations for research are detailed in this article as well as cross-cutting research themes affecting all areas, including racial and economic diversity, geographical region, cohort, and intergenerational linkages. DISCUSSION: Given the vulnerability of older persons to environmental threats detailed by the consensus conference, conferees recommended that research on these topics be urgently promoted, both by researchers and by funding agencies.

A Community-Based Participatory Critique of Social Isolation Intervention Research for Community-Dwelling Older Adults.

This article examines the dialogue that occurred within the structure of a Research-to-Practice Consensus Workshop that critiqued academic research priorities regarding social isolation among community-dwelling older adults and identified practice-based suggestions for a social isolation research agenda. The investigators adapted the scientific consensus workshop model to include expert practitioners and researchers in a discussion of the current state and future directions of social isolation intervention research. The group's critique resulted in several key recommendations for future research including the need for a social isolation measure with specific capacity to identify isolated older adults during a community crisis. This study demonstrates that the Research-to-Practice Consensus Workshop model can be used successfully to identify priority areas for research that have implications for community practice, construct an evidence base more relevant for community application, strengthen existing community-researcher partnerships, and build agency and practitioner capacity to take part in community-based participatory research.

A facility specialist model for improving retention of nursing home staff: results from a randomized, controlled study.

PURPOSE: This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. DESIGN AND METHODS: We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and Connecticut and randomly assigned to treatment and control conditions. Staff outcomes were measured through certified nursing assistant interviews, and turnover rates were measured over the course of the year. In the intervention condition, a staff member was selected to be the facility retention specialist, who would advocate for and implement programs to improve staff retention and commitment throughout the facility. Retention specialists received an intensive 3-day training in retention leadership and in a number of evidence-based retention programs. Ongoing support was provided throughout the project. RESULTS: Treatment facilities experienced significant declines in turnover rates compared to control facilities. As predicted, we found positive effects on certified nursing assistant assessments of the quality of retention efforts and of care provided in the facility; we did not find effects for job satisfaction or stress. IMPLICATIONS: The study provides evidence for the effectiveness of the retention specialist model. Findings from a detailed process evaluation suggest modifications of the program that may increase program effects.

The CITRA pilot studies program: mentoring translational research.

PURPOSE: We developed an innovative pilot studies program to foster partnerships between university researchers and agencies serving older people in New York City. The development of researchers willing to collaborate with frontline service agencies and service agencies ready to partner with researchers is critical for translating scientific research into evidence-based practice that benefits community-dwelling older adults. DESIGN AND METHODS: We adapted the traditional academic pilot studies model to include key features of community-based participatory research. RESULTS: In partnership with a network of 265 senior centers and service agencies, we built a multistep program to recruit and educate scientific investigators and agencies in the principles of community-based research and to fund research partnerships that fulfilled essential elements of research translation from university to community: scientific rigor, sensitivity to community needs, and applicability to frontline practice. We also developed an educational and monitoring infrastructure to support projects. IMPLICATIONS: Pilot studies programs developing community-based participatory research require an infrastructure that can supplement individual pilot investigator efforts with centralized resources to ensure proper implementation and dissemination of the research. The financial and time investment required to maintain programs such as those at the Cornell Institute for Translational Research on Aging, or CITRA, may be a barrier to establishing similar programs.

The CITRA research-practice consensus-workshop model: exploring a new method of research translation in aging.

PURPOSE: On the basis of the experience of an extensive community-based research partnership in New York City, we developed an innovative process for bridging the gap between aging-related research and practice, using a consensus-workshop model. DESIGN AND METHODS: We adapted the traditional scientific consensus-workshop model to include translation of the research into nontechnical language and the involvement of practitioners in the process. We then applied the model to the specific issue of falls prevention among community-dwelling older adults. RESULTS: The dialogue and interaction among researchers and practitioners provided new insights beyond a traditional research review. Practitioners offered astute guidance for future research based on their day-to-day field experience. IMPLICATIONS: The recommendations that emerged from the workshop demonstrated the value of close interaction between the aging-related research and practice communities. The consensus-conference model has significant potential to establish a bridge between the worlds of research and practice in a variety of settings.

A cooperative communication intervention for nursing home staff and family members of residents.

PURPOSE: This article reports on a randomized, controlled study of Partners in Caregiving, an intervention designed to increase cooperation and effective communication between family members and nursing home staff. DESIGN AND METHODS: Participants included 932 relatives and 655 staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Parallel training sessions on communication and conflict resolution techniques were conducted with the family and staff in the treatment group, followed by a joint meeting with facility administrators. RESULTS: Positive outcomes were found for both family and staff members in the treatment group. Both groups showed improved attitudes toward each other, families of residents with dementia reported less conflict with staff, and staff reported a lower likelihood of quitting. IMPLICATIONS: Multiple studies report significant interpersonal stress between family members of nursing home residents and facility staff members. Partners in Caregiving appears to be an effective way to improve family-staff relationships in nursing homes.