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Nursing Home Peril
By Jamie Talan, Newsday
February 4, 2004
Elderly nursing home residents abused by other patients are often those with dementia who are fit enough to wander unattended and to invade other people's space, according to a new study.
The findings by Harvard School of Public Health researchers on resident-on-resident violence appear in this week's Journal of the American Medical Association.
"We now have a clearer picture of the patient at risk to suffer injuries at the hand of another patient," said Paul Dreyer, associate commissioner for the Center for Quality Assurance and Control at the Massachusetts Department of Public Health, the senior author of the three-year study. "There is no other data like this, and we will use this information to develop strategies to make such injuries less likely."
Massachusetts has a mandatory reporting system for nursing home patient injuries. In 2000, there were 1,200 reports of nursing home residents abused by other patients and most were minor incidents. But there was evidence of physical harm to 293 patients, including 39 fractures, six dislocations, 105 bruises or hematomas and 113 lacerations.
In the study, most of the patients abused were male, severely cognitively impaired and more physically fit, Dreyer said.
"At first, we thought that we would find that frail, elderly people were preyed upon in nursing homes," said Dreyer, who worked with Dr. Tomoko Shinoda-Tagawa and Dr. Ralph Leonard at Harvard's School of Public Health in Boston to collect and analyze the data. "But that was definitely not the case."
Only 12 percent of those who were hurt were dependent on others. And 42 percent of the patients abused exhibited wandering behavior that "invaded other people's space," Dreyer said. Eighty-five percent of the abused group was cognitively impaired.
"These are people who walk into a place where they shouldn't be," he added.
Dr. Gisele Wolf-Klein, director of geriatric education, research and training at Parker Jewish Institute for Health Care and Rehabilitation in New Hyde Park, believes that such problems occur because patients with dementia may not have the ability to judge a situation as dangerous. What's more, staff in nursing homes are inadequate to provide one-on-one attention for any individual patient, including those who wander.
Laws are written in such a way that patients receive about three hours of hands-on care by nurses or aides every day, Wolf-Klein said. "The rest of the time, you are on your own."
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