Resident-to-resident elder mistreatment and police contact in nursing homes: findings from a population-based cohort.

OBJECTIVES

To determine the frequency and nature of police contact with a well-characterized cohort of originally community-dwelling older adults who were subsequently placed in long-term care facilities and to describe in more quantitative and qualitative detail episodes of resident-to-resident elder mistreatment (RREM), which constituted the most common reason for police involvement in long-term care facilities.

DESIGN

Qualitative and quantitative study of the characteristics of nursing home residents who engaged in resident-to-resident mistreatment. The study melded longitudinal data from an observational cohort of community-dwelling older adults subsequently placed in long-term care facilities and cross-sectional data from nursing home and police records.

SETTING

Nursing homes.

PARTICIPANTS

Forty-two of 747 older adults placed in long-term care facilities who were members of the original New Haven Established Populations for Epidemiological Studies in the Elderly (EPESE) were involved in 79 separate incidents. These 747 nursing home residents were derived from 2,321 subjects in the study who were alive and community dwelling in 1985 and then subsequently placed in nursing homes between 1985 and 1995. EPESE cohort members who were placed in nursing homes were identified through a linkage to the Connecticut Long-Term Care Registry. The cohort was also linked to police records in the same community for the follow-up years 1985 to 1995.

MEASUREMENTS

Simple descriptive statistics were used to explicate reasons for police calls to the long-term care facilities where these individuals resided. Demographic and clinical data were obtained from annual EPESE interviews, which continued after long-term care placement. Police incident reports were abstracted to determine the reasons for police involvement; transcripts of police reports were reviewed qualitatively for episodes of RREM.

RESULTS

During the follow-up period, police were called to investigate 79 incidents involving 42 cohort members placed in nursing homes. The most common reason (89% of incidents) for police to investigate an episode involving a cohort member was for simple assault in which the subject was the perpetrator or victim of resident-to-resident mistreatment. Several qualitative typologies of this phenomenon emerged. Less common causes for police interdiction were elopement, theft, and alleged staff abuse. Cohort members were more likely to interact with police when community dwelling than after they entered the nursing home (30.2% vs 5.6%, P<.001). When police contact occurred with nursing home residents, it was much more likely to be for violent episodes than in community-dwelling subjects (90% vs 17%, P<.001).

CONCLUSION

Police had substantial contact with cohort members who became nursing home residents in this study, primarily to investigate RREM but also for other incidents. Further research should be conducted on the epidemiology, causes, and prevention of resident-to-resident aggressive behaviors in long-term care facilities, which were the major reason for police involvement.