Turkish Journal of Geriatrics 2008 , Vol 11, Issue 1
Rush University, Department of Medicine, Section of Geriatric and Palliative Medicine, Chicago, IL, ABD M.C.was a 76 year-old physically and cognitively impaired (advanced dementia) resident of a 249 bed, Medicare certified SNF. On July 30, 2005, she was found asphyxiated to death with a plastic bag wrapped around her head and a pillow on her face. County medical examiner ruled her death a homicide. Criminal investigators were able to gather enough evidence to charge her roommate, who also suffered from dementia. The suspect who died of natural causes a month later in another SNF did not have a history of violence. Yet, her frustration with her roommate's constant "crying out" was known. Nursing home residents comprise a large and rapidly growing segment of our national population. In long-term care settings safety is one of the most critical aspects of quality of care as residents depend on others for their wellbeing. Efforts have been made to improve safety of this vulnerable population by limiting unintentional injury and intentional injury as a result of staff abuse/neglect. Little attention, however, has been directed to injury inflicted by other residents. Aggressive behavior resulting from cognitive impairment among residents of long-term care facilities, which can potentially result in catastrophic consequences as in our case, remains virtually unstudied. Aggressive behavior in these settings is a frequent and complex problem, occurring weekly or more often in 22.6 to 91% of populations studied. A number of recent reports suggest that safety of nursing home residents may be further jeopardized due to cross-subsidization efforts that lead to large numbers of ex-convicts and younger adult psychiatric patients being placed in federally funded long term care facilities. These reports, coupled with widely publicized horror stories of neglect and abuse had considerable negative impact on the public perception of nursing homes. Residents' families are rightfully concerned for the safety of their loved ones and these concerns often translate into global dissatisfaction with the “long-term care experience” and high litigation rates. The road to mending the reputation of nursing homes as "safe havens of healing" will be a long and arduous. At presents, there is need for research to better characterize the diverse composition of nursing home populations. It is also imperative to develop tools for detection of early predictors of hostility among residents. Such tools can make timely intervention possible and help us prevent many, if not all, potentially tragic outcomes. Keywords : Nursing homes, Violence, Wounds and injuries, Homicide, Dementia, Aged