Factors associated with the prevalence of violent behaviour among residents living in nursing homes

The aim of this study was to investigate the associations between environmental and organisational factors as well as resident and caregiver characteristics in nursing home wards with a high respectively low prevalence of residents with violent behaviour. Earlier studies have indicated that different factors are related to violent behaviour among residents living in nursing homes, such as environmental and organisational variations, and resident and caregiver characteristics. However, few studies have simultaneously examined the relationship between these factors. A cross-sectional descriptive survey design. The study was performed in 10 nursing homes consisting of 33 wards. Data were collected using the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale. Variables concerning organisation and environment were gathered by means of a questionnaire. Differences between wards with high (HPW) or low prevalence of violence (LPW) were analysed. In HPWs, the prevalence of behaviour and psychiatric symptoms, residents needing assistance with dressing and psychological workload were found to be higher, while job satisfaction was lower compared to LPWs. This study has also shown that caregivers in HPWs had less experience of working with older people and they experienced their working climate as less positive. Furthermore, HPWs had more residents, lower caregiver-to-resident ratio and longer corridors, and caregivers in these wards experienced more difficulties to supervise the residents. This study has shown that the prevalence of residents with violent behaviour is significantly associated with other behavioural and psychiatric symptoms and ADL (activities of daily life)-functions, as well as caregivers' experiences of job satisfaction and psychological workload. This study underlines the importance of a multifactorial approach to understand the prevalence of violent behaviour, including the physical environment, organisational factors, as well as characteristics of the resident and the caregiver.