title: Modifiable factors related to abusive behaviors in nursing home residents with dementia.
abstract: OBJECTIVE
  To determine modifiable factors related to abusive behaviors in nursing home residents with dementia.
  
  
  METHODS
  Analysis of Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI) information.
  
  
  METHODS
  We used MDS-RAI data from 8 Dutch nursing homes and 10 residential homes that volunteered to collect data for care planning. We included the data of residents within a 12-month time window for each facility separately, resulting in a range from April 4, 2007, to December 1, 2008.
  
  
  METHODS
  We selected 929 residents older than 65 with Alzheimer's disease or other dementia who were dependent in decision making and not comatose.
  
  
  METHODS
  Cognitive Performance Scale, MDS Depression Scale and several individual items from the MDS-RAI (ability to understand others, verbally and physically abusive behavioral symptoms, resist care, diagnosis of Alzheimer's disease and of dementia other than Alzheimer's disease, diagnosis of depression, presence of delusions, hallucinations, pain frequency and constipation, and number of days receiving medications).
  
  
  RESULTS
  Resistiveness to care, related to lack of understanding, depression, hallucinations and delusions, was strongly related to abusive behaviors. Presence of depressive symptoms and delusions was also related to abusive behaviors independent of resistiveness to care. Only very few residents who understood others and were not depressed were abusive.
  
  
  CONCLUSIONS
  Abusive behaviors may develop from lack of understanding leading to resistiveness to care. Behavioral interventions preventing escalation of resistiveness to care into combative behavior and the treatment of depression can be expected to decrease or prevent abusive behavior of most nursing home residents with dementia.
authors.affiliation: School of Aging Studies, University of South Florida, Tampa, FL, and Charles University 3rd Medical Faculty, Prague, Czech Republic. lvolicer@cas.usf.edu
authors.forename: Ladislav
authors.initials: L
authors.lastname: Volicer
authors.forename: Jenny T
authors.initials: JT
authors.lastname: Van der Steen
authors.forename: Dinnus H M
authors.initials: DH
authors.lastname: Frijters
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy; D015331:Cohort Studies; D016208:Databases, Factual; D003704:Dementia / Q000150:complications / Q000523:psychology* / Q000628:therapy; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D011336:Probability; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D016312:Treatment Refusal