ITHACA, N.Y. — For many adults who find themselves providing more frequent care for their aging parents, the move to a cozy assisted living facility should be a comforting experience. Adult children expect that their elderly loved ones will have a safe, supportive environment where they can enjoy their golden years. However, a stunning new study shows that a startling reality lurks behind closed doors – the threat of aggression from their fellow residents.
Researchers from Cornell University and Columbia University Irving Medical Center discovered a troubling phenomenon in assisted living facilities across the United States: resident-to-resident aggression (RRA). Their study, published in JAMA Network Open, found that over the course of a month, a staggering 15.2 percent of assisted living residents experienced some form of aggression from their neighbors. That number jumped to nearly 25 percent when looking at a full year.
So, what exactly does RRA really mean? It’s not just the occasional heated argument over the remote control. The study found that verbal abuse was the most common form, affecting 11.2 percent of residents monthly. This includes aggressive seniors screaming, insulting others, or attempting to scare or boss around fellow residents.
However, physical aggression was also alarmingly prevalent, with 4.4 percent of residents experiencing hitting, kicking, biting, or other assaults each month. Even sexual aggression, while less common, still affected nearly one percent of residents. Other types of RRA, like damaging property or making threatening gestures, impacted 7.5 percent of residents monthly.
To put these numbers in context, consider that over 800,000 Americans currently reside in assisted living facilities. If the rates found in this study hold true nationally, that means in any given month, over 120,000 of these vulnerable individuals are being subjected to aggressive behavior from other seniors — not the staff employed to take care of them.
The effects of RRA can be devastating. Previous research has linked it to physical injury, psychological distress, and even death in extreme cases. For seniors who have sought out assisted living as a safe haven, this reality can be particularly shattering.
“In geriatrics, even minor incidents, physical or emotional, can get you into trouble,” says Dr. Mark Lachs, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine, in a media release. “You can’t weather physical or verbal insults the way you can when you’re younger, and they really do reduce the quality of life in these environments.”
What’s driving this epidemic of aggression?
The study offers some clues. Residents of memory care units, which cater to individuals with Alzheimer’s and other cognitive impairments, were more than twice as likely to engage in RRA compared to those in other units. This suggests that the disinhibition and behavioral changes that often accompany dementia may be a significant risk factor.
Interestingly, the study also found that residents with good vision and hearing were more likely to be involved in RRA than those with sensory impairments. It’s possible that those who can see and hear clearly are more readily drawn into conflicts. Mobility also played a role – residents who could walk unassisted were nearly twice as likely to engage in RRA as those who couldn’t.
However, cognitive status itself didn’t emerge as a clear predictor. Rates of RRA were similar across the spectrum, from no impairment to severe dementia. This means that even those with intact cognition can be swept up in aggressive interactions.
So, what can be done to stem the tide of RRA? The researchers stress the urgent need for intervention strategies tailored to the assisted living setting. This could involve training staff to recognize and defuse aggressive situations, modifying environments to reduce triggers, and providing therapeutic outlets for residents’ frustrations.
“Interpersonal aggression is common in assisted living facilities and staff are inadequately trained to deal with it,” notes Karl Pillemer, the Hazel E. Reed Professor of Psychology in Cornell’s College of Human Ecology (CHE) and professor of gerontology in medicine at Weill Cornell Medicine.
But family members also have a role to play. Regular visits and check-ins can help ensure that loved ones are not being victimized. Encouraging open communication with facility staff is crucial. Also, being attuned to warning signs, like unexplained bruises or changes in mood or behavior, can help catch RRA early.
On a policy level, the study authors call for a review of current regulations around RRA in assisted living. While nursing homes have federal oversight, assisted living facilities are governed by a patchwork of state regulations. Standardized guidelines for preventing, reporting, and responding to RRA could go a long way in protecting residents.
The shocking prevalence of RRA uncovered by this study is a wake-up call for the assisted living industry and for society as a whole. As our population ages and more and more seniors turn to assisted living, ensuring their safety and dignity must be a top priority. No one should have to live in fear of their neighbors, especially in their twilight years and in a setting meant to provide comfort and care.
StudyFinds Editor Chris Melore contributed to this report.