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The Prevalence of Resident-to-Resident Elder Mistreatment in Nursing HomesResident-to-Resident Elder Mistreatment in Nursing Homes

Mark S. Lachs, MD, MPH; Jeanne A. Teresi, EdD, PhD; Mildred Ramirez, PhD; Kimberly van Haitsma, PhD; Stephanie Silver, MPH; Joseph P. Eimicke, MS; Gabriel Boratgis, MPH; Gail Sukha, BA; Jian Kong, MS; Alexandra M. Besas, RN; Maria Reyes Luna, AS; and Karl A. Pillemer, PhD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 14 June 2016.


From Weill Cornell Medical College and Columbia University Stroud Center at New York State Psychiatric Institute, New York; the College of Human Ecology, Cornell University, Ithaca, and Research Division, Hebrew Home at Riverdale, Riverdale, New York; College of Nursing, The Pennsylvania State University, University Park, and the Polisher Research Institute at the Madlyn and Leonard Abramson Center for Jewish Life, North Wales, Pennsylvania.

Acknowledgment: The investigators are indebted to the patients, families, and facilities who participated in this research and to Chelsie Burchett for assistance in preparation of the manuscript.

Grant Support: In part by the National Institute on Aging (AG014299-06A2 and R03AG049266), National Institute of Justice (FYO 42USC3721), New York State Department of Health Dementia Grant Program (C-022657), and an Edward R. Roybal Center grant from the National Institute on Aging (P30 AG22845-01). Dr. Lachs received a National Institute on Aging mid-career mentoring award in patient-oriented research (K24AG022399).

Disclosures: Dr. Lachs reports grants from the National Institutes of Health during the conduct of the study, has served as both a paid and pro bono expert witness in criminal and civil cases related to elder abuse and neglect, and has testified before the U.S. Senate Committee on Aging on the topic of elder abuse. Ms. Silver reports grants from Hebrew Home at Riverdale during the conduct of the study. Mr. Eimicke reports grants from Research Division, Hebrew Home at Riverdale, during the conduct of the study. Ms. Sukha reports grants from the National Institute on Aging during the conduct of the study. Mr. Kong reports grants and programmed and analyzed data from Hebrew Home at Riverdale during the conduct of the study. Ms. Besas and Ms. Reyes Luna report grants from the National Institute on Aging during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1209.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol: Available from Dr. Lachs (e-mail, mslachs@med.cornell.edu). Statistical code and data set: Code for selected analyses and partial data are available at www.icpsr.umich.edu/icpsrweb/NACJD/archive.jsp.

Requests for Single Reprints: Mark S. Lachs, MD, MPH, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, Cornell University, 1300 York Avenue, New York, NY 10065; e-mail, mslachs@med.cornell.edu.

Current Author Addresses: Dr. Lachs: Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, Cornell University, 1300 York Avenue, New York, NY 10065.

Drs. Teresi and Ramirez, Ms. Silver, Mr. Eimicke, Mr. Boratgis, Ms. Sukha, Mr. Kong, Ms. Besas, and Ms. Luna: Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, Riverdale, NY 10471.

Dr. van Haitsma: College of Nursing, The Pennsylvania State University, 203 Health and Human Development East, University Park, State College, PA 16801.

Dr. Pillemer: Department of Human Development, Cornell University, MVR Hall, Ithaca, NY 14853.

Author Contributions: Conception and design: M.S. Lachs, J.A. Teresi, M. Ramirez, K.A. Pillemer.

Analysis and interpretation of the data: M.S. Lachs, J.A. Teresi, M. Ramirez, K. van Haitsma, J.P. Eimicke, J. Kong, K.A. Pillemer.

Drafting of the article: M.S. Lachs, J.A. Teresi, K. van Haitsma, S. Silver, K.A. Pillemer.

Critical revision of the article for important intellectual content: M.S. Lachs, J.A. Teresi, M. Ramirez, K. van Haitsma, K.A. Pillemer.

Final approval of the article: M.S. Lachs, J.A. Teresi, M. Ramirez, S. Silver, J.P. Eimicke, K.A. Pillemer.

Provision of study materials or patients: M.S. Lachs, M. Ramirez.

Statistical expertise: M.S. Lachs, J.A. Teresi, J.P. Eimicke, J. Kong.

Obtaining of funding: M.S. Lachs, K.A. Pillemer.

Administrative, technical, or logistic support: G. Boratgis, K.A. Pillemer.

Collection and assembly of data: J.A. Teresi, S. Silver, G. Boratgis, G. Sukha, A.M. Besas, M. Reyes Luna, K.A. Pillemer.


Ann Intern Med. 2016;165(4):229-236. doi:10.7326/M15-1209
© 2016 American College of Physicians
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Background: Resident-to-resident elder mistreatment (R-REM) in nursing homes can cause physical and psychological injury and death, yet its prevalence remains unknown.

Objective: To estimate the prevalence of physical, verbal, and sexual R-REM in nursing home residents and subgroups.

Design: 1-month observational prevalence study.

Setting: 5 urban and 5 suburban New York state nursing homes.

Participants: 2011 residents in 10 facilities randomly selected on the basis of size and location; 83% of facilities and 84% of eligible residents participated.

Measurements: R-REM was identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports.

Results: 407 of 2011 residents experienced at least 1 R-REM event; the total 1-month prevalence was 20.2% (95% CI, 18.1% to 22.5%). The most common forms were verbal (9.1% [CI, 7.7% to 10.8%]), other (such as invasion of privacy or menacing gestures) (5.3% [CI, 4.4% to 6.4%]), physical (5.2% [CI, 4.1% to 6.5%]), and sexual (0.6% [CI, 0.3% to 1.1%]). Several clinical and contextual factors (for example, lower vs. severe levels of cognitive impairment, residing on a dementia unit, and higher nurse aide caseload) were associated with higher estimated rates of R-REM.

Limitations: Most facilities were relatively large. All R-REM cases may not have been detected; resident and staff reporting may be subject to recall bias.

Conclusion: R-REM in nursing homes is highly prevalent. Verbal R-REM is most common, but physical mistreatment also occurs frequently. Because R-REM can cause injury or death, strategies are urgently needed to better understand its causes so that prevention strategies can be developed.

Primary Funding Source: National Institute on Aging.

Figures

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Figure 2.

Adjudication process.

R-REM = resident-to-resident elder mistreatment.* Instances of R-REM were identified on the basis of at least 1 report from any of 6 sources.

† Events adjudicated as R-REM had to involve at least 2 residents; events involving staff or family members were excluded.

‡ For urban facilities, there was random selection of 30 residents per facility; for suburban facilities, there was 1 person for each R-REM case per facility.

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