The relationship between self-destructive behaviour and nursing home environment.

The aim of this study was to explore the relationship between self-destructive behaviour and nursing home environment. We performed a cross-sectional study comprising 647 residents in 11 nursing homes in Sydney, Australia using the Harmful Behaviours Scale (HBS), Abbreviated Mental Test Scale and the Resident Classification Index. The Directors of Nursing completed a questionnaire that rated physical design, staff and resident characteristics and demographics were obtained from nursing home records. On regression analysis a greater number of design features for frail and residents with dementia in general, and increased security measures were associated with greater HBS total score and risk-taking and passive self-harm subscales. A residential environment in which the residents were more functionally dependent and more likely to be in a shared room, managerial policies less geared towards managing difficult behaviour and less staff availability and training were associated with the 'uncooperativeness' factor. There were no significant predictors of the other two factors. The relationship between nursing home environment and self-destructive behaviours and the environment is complex and there needs to be an individualized approach to placement.