In the past two decades, the media has exposed a long covert crime — abuse against the elderly. Often the violation comes from the hand of a paid caregiver or, in some cases, a relative.
This publicity followed research conducted among older adults living in the community who it was discovered often suffered transgressions like violence or neglect perpetrated by a family member or trusted helper.
In recent years, experts turned their focus to nursing home staff caring for the most vulnerable patients, such as those with dementia or Alzheimer’s disease.
Yet, one form of abuse has received little attention.
Resident-to-Resident Harassment Often Overlooked
This often ignored form of nursing home abuse is called resident-to-resident elder mistreatment (R-REM), and it is more common than one might expect.
Gerontologist Dr. Karl Pillemer of Cornell University discovered that 20% of nursing home residents experienced a negative or aggressive encounter with another resident in just a four week period.
Those encounters include:
- Verbal abuse
- Physical abuse
- Inappropriate sexual behavior
- Invasion of privacy
Pillemer conducted his study with co-author Dr. Mark Lachs, and the two found that the profile of the abuser usually is one who is cognitively disabled but able to walk.
“Often their underlying dementia or mood disorder can manifest as verbally or physically aggressive behavior,” said Dr. Pillemer.
Some indications show underreporting from nursing home staff when these events occur.
Case Studies Show Staff Neglect of Issue
In one case study, a research assistant witnessed a resident come into a room, pull down his pants, and begin to fondle himself in front of another patient who was in his bed.
A certified nursing assistant (CNA) was also in the room and asked the man to stop. He responded by cursing at the CNA and walking out of the room. The resident in the bed replied that this man repeatedly exhibited this unwanted behavior in his room.
Instead of reporting the issue, the CNA concluded the issue was resolved and did nothing.
In another case study, one resident was stabbing another resident in the arm with a fork while the CNA ignored the altercation.
When the research assistant questioned the CNA, she then moved one of the women to another area and took no other action. The research assistant later spoke to one of the women and found out she hated living there and felt alone with no friends.
The study revealed that mistreatment impacted 19.8% of residents in varying degrees:
- Verbal incidents such as cursing, screaming, or yelling at another (16%)
- Physical incidents such as hitting, kicking, or biting (5.7%)
- Sexual incidents such as genital exposure, touching other residents inappropriately, or attempting to gain sexual favors (1.3%)
- Entering another resident’s room uninvited and rifling through their belongings (10.5%)
Pillemer and Lachs randomly selected 10 skilled nursing facilities in the state of New York, each with more than 2,000 residents. Their data collection included interviews and reports, direct observation, and a research-based questionnaire for both residents and staff.
Pillemer also blames the close living conditions as a probable contributor.
“It’s no surprise that these individuals are more likely to partake in arguments, shouting matches, and pushing and shoving, particularly in such close, crowded quarters,” he said.
It’s unsettling news for those with loved ones in nursing homes.
The researchers recommend programs that educate and train nursing home staff to recognize and report R-REM, which include guidelines to follow when incidents occur.
“We urgently need strategies to address this under-recognized problem, which affects fully one-fifth of all residents, erodes their quality of life, and is stressful for staff to manage,” said Dr. Lachs who co-chairs the Division of Geriatrics and Gerontology at Cornell.