Self-destructive behaviors in nursing home residents.
OBJECTIVE
To validate the Harmful Behaviors Scale (HBS) as a measure of direct and indirect self-destructive behaviors in nursing home residents and to determine the prevalence of self-destructive behaviors and their relationship to other variables.


METHODS
A cross-sectional study.


METHODS
Eleven nursing homes in the eastern suburbs of Sydney, Australia.


METHODS
Six hundred ten nursing home residents aged 65 and older.


METHODS
Instruments used were the HBS, Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale (FAST), Even Briefer Assessment Scale for Depression (EBAS-Dep), and the suicide item from the structured Hamilton Depression Rating Scale. Data on diagnoses of dementia, depression, or psychotic disorder; prescription of psychotropic medication; and demographics were obtained from nursing home records.


RESULTS
On the HBS, indirect harmful behaviors occurred at least weekly in 61% of subjects, and direct harmful behaviors occurred in 14% of subjects. The HBS total score was significantly positively correlated with the BEHAVE-AD score (Pearson's r=0.679, P <.001) but not with the EBAS-Dep "wish for death" item and total score. HBS scores were significantly higher in residents scoring greater than zero on the Hamilton suicide item (F=1.380, df=3,325, P=.249). Stepwise multiple linear regression indicated that younger age, chart diagnosis of dementia, greater incapacity as measured by FAST, and a higher Hamilton suicide item score predicted a higher HBS total score.


CONCLUSIONS
Self-destructive behaviors are common in nursing home residents and are mostly related to dementia. There was little evidence of a relationship between depression and self-destructive behaviors.
Draper
Brian
B
School of Psychiatry, University of New South Wales, Sydney, Australia. b.draper@unsw.edu.au
Brodaty
Henry
H
Low
Lee-Fay
LF
Richards
Vicki
V
Paton
Helen
H
Lie
David
D
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D009735:Nursing Homes; D015203:Reproducibility of Results; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D018709:Statistics, Nonparametric