title: Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review.
abstract: BACKGROUND
  resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes.
  
  
  OBJECTIVE
  the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes.
  
  
  METHODS
  in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions).
  
  
  RESULTS
  eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression.
  
  
  CONCLUSIONS
  we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.
authors: Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.
authors: Noha
authors: N
authors: Ferrah
authors: Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.
authors: Briony J
authors: BJ
authors: Murphy
authors: Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.
authors: Joseph E
authors: JE
authors: Ibrahim
authors: Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.
authors: Lyndal C
authors: LC
authors: Bugeja
authors: The Victoria and Tasmania Dementia Training Study Centre, Australian Centre for Evidence Based Aged Care, Australian Institute for Primary Care and Ageing, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria 3086, Australia.
authors: Margaret
authors: M
authors: Winbolt
authors: National Ageing Research Institute and Melbourne Health, Melbourne, Victoria, Australia.
authors: Dina
authors: D
authors: LoGiudice
authors: Western Australian Centre for Health and Ageing, Western Australian Institute for Medical Research, University of Western Australia, Crawley, Western Australia, Australia Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Leon
authors: L
authors: Flicker
authors: Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.
authors: David L
authors: DL
authors: Ranson
mesh_terms: D000368:Aged; D000374:Aggression; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*
keywords: aggression; death; nursing home; older people; physical injury; resident-to-resident; systematic review