The Prevalence of Resident-to-Resident Elder Mistreatment in Nursing Homes

Background: Resident-to-resident elder mistreatment (R-REM) in nursing homes can cause physical and psychological injury and death, yet its prevalence remains unknown. Objective: To estimate the prevalence of physical, verbal, and sexual R-REM in nursing home residents and subgroups. Design: 1-month observational prevalence study. Setting: 5 urban and 5 suburban New York state nursing homes. Participants: 2011 residents in 10 facilities randomly selected on the basis of size and location; 83% of facilities and 84% of eligible residents participated. Measurements: R-REM was identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports. Results: 407 of 2011 residents experienced at least 1 R-REM event; the total 1-month prevalence was 20.2% (95% CI, 18.1% to 22.5%). The most common forms were verbal (9.1% [CI, 7.7% to 10.8%]), other (such as invasion of privacy or menacing gestures) (5.3% [CI, 4.4% to 6.4%]), physical (5.2% [CI, 4.1% to 6.5%]), and sexual (0.6% [CI, 0.3% to 1.1%]). Several clinical and contextual factors (for example, lower vs. severe levels of cognitive impairment, residing on a dementia unit, and higher nurse aide caseload) were associated with higher estimated rates of R-REM. Limitations: Most facilities were relatively large. All R-REM cases may not have been detected; resident and staff reporting may be subject to recall bias. Conclusion: R-REM in nursing homes is highly prevalent. Verbal R-REM is most common, but physical mistreatment also occurs frequently. Because R-REM can cause injury or death, strategies are urgently needed to better understand its causes so that prevention strategies can be developed.