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Chapter 14 - Management of Violence in Older Adults

from Section 4 - Management in Other Groups

Published online by Cambridge University Press:  09 May 2023

By
Jonathan Waite  and
Juliette Brown
Edited by
Masum Khwaja  and
Peter Tyrer
Masum Khwaja
Affiliation:
Imperial College of Science, Technology and Medicine, London
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
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Summary

Violence from older adults is a challenge for healthcare services. Risk factors include those common to working-age adults, namely substance misuse, active psychotic symptoms and inadequate care, and those more typical in older age, including cognitive impairment, acute confusion and pain. Aggression is a barrier to good care and a challenge to manage in older adults who are more vulnerable to medication effects and side effects. Medications must be used with caution. Prevention of violence through sensitive person-centred care and management of risk factors is recommended, as is non-pharmacological management. Here, we review management through non-pharmacological and pharmacological measures.

Keywords

Olderviolencemanagementassessmentmedication
Type
Chapter
Information
The Prevention and Management of Violence
Guidance for Mental Healthcare Professionals
 , pp. 234 - 247
Publisher: Cambridge University Press
Print publication year: 2023

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References

Dixon, D. A five year analysis of physical assaults against NHS staff in England. SIRS / RPA Violence Report 2010 – 2015. NHS Protect. 2015. http://webarchive.nationalarchives.gov.uk/20170726163554/https://www.nhsbsa.nhs.uk/crime-prevention/nhs-protect-statistics [Accessed April 25, 2021].Google Scholar
Brown, J., Fawzi, W. and McCarthy, C. et al. Safer Wards: Reducing violence on older people’s mental health wards. BMJ Quality Improvement Reports 2015 4(1). u207447.w2977.CrossRefGoogle ScholarPubMed
Healthcare Commission. National Audit of Violence 2006–7: Final Report – Working Age Adult Services. Royal College of Psychiatrists’ Centre for Quality Improvement. 2008.Google Scholar
Healthcare Commission. National Audit of Violence 2006–7: Final Report – Older People’s Services. Royal College of Psychiatrists’ Centre for Quality Improvement. 2008.Google Scholar
Griffiths, A., Knight, A., Harwood, R. et al. Preparation to care for confused older patients in general hospitals: A study of UK health professionals. Age and Ageing 2014; 43:521–7.Google Scholar
Sampson, E. L., White, N., Leurent, N. B. et al. Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: prospective cohort study. British Journal of Psychiatry 2014; 205:189–96.Google Scholar
Cheung, T. and Yip, P. S. F. Workplace violence towards nurses in Hong Kong: Prevalence and correlates. BMC Public Health 2017; 17:196.Google Scholar
Johansen, I. H., Baste, V., Rosta, J. et al. Changes in the prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: A repeated cross sectional survey. BMJ Open 2017; 7:e107757.Google Scholar
Shafran-Tikva, S., Zelker, R., Stern, Z. and Chinitz, D. Workplace violence in a tertiary Israeli hospital: A systematic analysis of types of violence, the perpetrators and hospital departments. Israel Journal of Health Policy Research 2017; 6:43.Google Scholar
Claudius, I. A., Desai, S., Davis, E. and Henderson, S. Case-controlled analysis of patient-based risk factors for assault in the health care workplace. Western Journal of Emergency Medicine 2017; 18:1153–58.Google Scholar
Cheung, T., Lee, P. H. and Yip, P. S. F. Workplace violence towards physicians and nurses: Prevalence and correlates in Macau. International Journal of Environmental Research and Public Health 2017; 14:879.Google Scholar
Information Services Division. Care Home Census 2011: Interim Analysis. NHS National Services Scotland. 2011.Google Scholar
Alzheimer Society. Dementia UK: Updated Second Edition. Alzheimer’s Society. 2014.Google Scholar
Donaldson, C., Tarrier, N. and Burns, A. The impact of the symptoms of dementia on caregivers. British Journal of Psychiatry 1997; 170:62–68.Google Scholar
Zeller, A., Dassen, T., Kok, G. et al. Factors associated with resident aggression toward caregivers in nursing homes. Journal of Nursing Scholarship 2012; 44:249–57.CrossRefGoogle ScholarPubMed
Zeller, A., Hahn, S., Needham, I. et al. Aggressive behavior of nursing home residents towards caregivers: A systematic literature review. Geriatric Nursing 2009; 30:174–87.Google Scholar
Ko, A., Fukahori, H., Igarashi, A. et al. Aggression exhibited by older dementia clients toward staff in Japanese long-term care. Journal of Elder Abuse and Neglect 2012; 24; 1–16.Google Scholar
Mallon, C., Krska, J. and Gammie, S. Views and experiences of care home staff on managing behaviours that challenge in dementia: A national survey in England. Aging and Mental Health 2018; 25:1–8.Google Scholar
Ferrah, N., Murphy, B. J, Ibrahim, J. E. et al. Resident-to-resident physical aggression leading to injury in nursing homes: A systematic review. Age and Ageing 2015; 44:356–64.CrossRefGoogle ScholarPubMed
Prince, M., Knapp, M., Guerchet, M. et al. Dementia UK: Update Second Edition report produced by King’s College London and the London School of Economics for the Alzheimer’s Society, 2014.Google Scholar
Savva, G. M, Zaccai, J., Matthews, F. E. et al. Prevalence correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry 2009; 194:212–19.Google Scholar
Burns, A., Jacoby, R. and Levy, R. Psychiatric phenomena in Alzheimer’s Disease. IV: Disorders of behaviour. British Journal of Psychiatry 1990; 157:86–94.Google Scholar
Lyketsos, C. G., Steinberg, M., Tschanz, J. T. et al. Mental and behavioral disturbances in dementia: Findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry 2000 57:708–14.Google Scholar
Cooper, C., Selwood, A., Blanchard, M. and Livingston, G. Abusive behaviour experienced by family carers from people with dementia: The CARD (caring for relatives with dementia) study. Journal of Neurology, Neurosurgery, and Psychiatry 2010; 81:592–6.CrossRefGoogle ScholarPubMed
Andrén, S. and Elmståhl, S. Effective psychosocial intervention for family caregivers lengthens time elapsed before nursing home placement of individuals with dementia: A five-year follow-up study. International Psychogeriatrics 2008 Dec;20(6):1177–92.Google Scholar
Banerjee, S., Murray, J., Foley, B. et al. Predictors of institutionalisation in people with dementia. Journal of Neurology, Neurosurgery, and Psychiatry 2003; 74(9):1315–16.Google Scholar
Brown, J. Prognosis and Planning. In Evans, S., Garner, J. and Darnley-Smith, R. (eds.) Psychodynamic Approaches to the Experience of Dementia. London, Routledge, 2020, pp. 41–55.Google Scholar
National Institute for Health and Care Excellence. Violence and Aggression: short-term management in mental health, health and community settings (NG10). NICE. 2015.Google Scholar
Royal College of Nursing. Restraint Revisited: Rights, Risk, Responsibility: Guidance for Nursing Staff. RCN. 2004.Google Scholar
Scottish Intercollegiate Guidelines Network. Risk reduction and Management of delirium. 2019. www.sign.ac.uk/media/1423/sign157.pdf [Accessed 25.04.2022].Google Scholar
Alzheimer’s Society. Aggressive behaviour (Factsheet 509LP). 2017. http://alzheimerwebstg.prod.acquia-sites.com/sites/default/files/pdf/factsheet_dementia_and_aggressive_behaviour.pdf [Accessed 25.04.2022].Google Scholar
National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline [NG97] 2018. www.nice.org.uk/guidance/ng97 [Accessed 25.04.2022].Google Scholar
National Institute for Health and Care Excellence. Antipsychotic medicines for treating agitation, aggression and distress in people living with dementia. www.nice.org.uk/guidance/ng97/resources/antipsychotic-medicines-for-treating-agitation-aggression-and-distress-in-people-living-with-dementia-patient-decision-aid-pdf-4852697005 [Accessed 25.04.2022].Google Scholar
Banerjee, S. The use of antipsychotic medication for people with dementia: Time for action. Department of Health. 2009.Google Scholar
Alzheimer Society. Reducing the Use of Antipsychotic Drugs: A Guide to the Treatment and Care of Behavioural and Psychological Symptoms of Dementia. Alzheimer Society. 2011.Google Scholar
Sturdy, D. Antipsychotic drugs in dementia: A best practice guide. Royal College of Nursing and Nursing Standards. 2012.Google Scholar
Howard, R., Burns, A. and Schneider, L. Antipsychotic prescribing to people with dementia during COVID-19. The Lancet Neurology 2020; 19(11):892.Google Scholar
NICE. Delirium: prevention, diagnosis and management. Clinical guideline [CG103] 2010 (2019). www.nice.org.uk/guidance/CG103 [Accessed 25.04.2022].Google Scholar
British Geriatrics Society and Royal College of Psychiatrists Good Practice Guide. Coronavirus: Managing delirium in confirmed and suspected cases. 2020. www.bgs.org.uk/sites/default/files/content/attachment/2020-03-26/BGS%20Coronavirus%20-%20Managing%20delirium%20in%20confirmed%20and%20suspected%20cases_0.pdf [Accessed 25.04.2022].Google Scholar
British Geriatrics Society & Royal College of Emergency Medicine. The Silver Book: Quality Care for Older People with Urgent and Emergency Care Needs. British Geriatrics Society. 2012.Google Scholar
Royal College of Psychiatrists College Report CR211. Our Invisible Addicts. 2018. www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2018-college-reports/our-invisible-addicts-2nd-edition-cr211-mar-2018 [Accessed 25.04.2022].Google Scholar
NICE. Alcohol-use disorders: diagnosis and management of physical complications. Clinical guideline [CG100] 2010 (updated: 12 April 2017). www.nice.org.uk/guidance/cg100 [Accessed 25.04.2022].Google Scholar
Sampson, E. L., White, N., Lord, K. et al. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: A longitudinal cohort study. Pain 2015 Apr;156(4):675–83.Google Scholar
Husebo, B. S., Ballard, C., Sandvik, R., Nilsen, O. B. and Dag, A. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 2011; 343 :d4065.Google Scholar
Sweeney, A., Clement, S., Filson, B. and Kennedy, A. Trauma-informed mental healthcare in the UK: What is it and how can we further its development? Mental Health Review Journal 2016:21: (3) 174–92.Google Scholar
Sweeney, A., Filson, B., Kennedy, A., Collinson, L. and Gillard, S. A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances 2018; 24: (5) 319–33.Google Scholar
Wilton, J. and Williams, A. Centre for Mental Health: Engaging with complexity. 2019. www.centreformentalhealth.org.uk/sites/default/files/2019-05/CentreforMH_EngagingWithComplexity.pdf [Accessed 25.04.2022].Google Scholar
PIECES Tool. www.interiorhealth.ca/sites/Partners/SeniorsCare/DementiaPathway/MiddleDementiaPhase/Documents/PIECES-ABCtool.pdf [Accessed 25.04.2022]Google Scholar
MDT podcast Episode 5.05 BPSD Management 2018 http://thehearingaidpodcasts.org.uk/5-05-bpsd-management-5/ [Accessed 25.04.2022].Google Scholar
Waddell, M. Discussion of Sandra Evans’ chapter ‘Where is the unconscious in dementia?’. In The Organic and the Inner World. Psychoanalytic Ideas series. 2009. Karnac, London, pp. 103–8.Google Scholar
Livingston, G., Huntley, J., Sommerlad, A. et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet Commissions 2020; 396:10248:413–46.Google Scholar
Livingston, G., Kelly, L., Lewis-Holmes, E. et al. Non-pharmacological interventions for agitation in dementia: systematic review of controlled trials. British Journal of Psychiatry 2014; 205:436–42.Google Scholar
Chenoweth, L., King, M. T., Jeon, Y. H. et al. Caring for aged dementia care resident study (CADRES) of person-centred care, dementia care mapping and usual care in dementia: A cluster randomised trial. Lancet Neurology 2009; 8:317–25.Google Scholar
McCallion, P., Toseland, R. W, Lacey, D., and Banks, S. Educating nursing assistants to communicate more effectively with nursing home residents with dementia. Gerontologist 1999; 39:546–58.Google Scholar
Cooke, M. L., Moyle, W., Shum, D. H. et al. A randomized, controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia. Aging and Mental Health 2010; 14:905–16.Google Scholar
Lin, Y., Chu, H., Yang, C. Y. et al. Effectiveness of group music intervention against agitated behavior in elderly persons with dementia. International Journal of Geriatric Psychiatry 2012; 26:670–8.Google Scholar
Sung, H. C., Lee, W. L., and Li, T. L. A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. International Journal of Geriatric Psychiatry 2012; 27:621–7.Google Scholar
Kales, H., Gitlin, L., and Lyketsos, C. G. Assessment and management of behavioral and psychological symptoms of dementia. BMJ 2015; 350:h369.Google Scholar
Ballard, C., Orrell, M., Moniz-Cook, E. et al. Improving mental health and reducing antipsychotic use in people with dementia in care homes: The WHELD research programme including two RCTs. Programme Grants for Applied Research 2020; 8(6).Google Scholar
O’Brien, J. T., Holmes, C., Jones, M. et al. Clinical practice with anti-dementia drugs: A revised (third) consensus statement from the British Association for Psychopharmacology. Journal of Psychopharmacology 2017;31(2):147–68.Google Scholar
Lonergan, E., Luxenberg, J., Colford, J. M. et al. Haloperidol for agitation in dementia. Cochrane Database of Systematic Reviews 2002; 2: CD002852.Google Scholar
Ballard, C. G., Birks, J. and Waite, J. Atypical antipsychotics for aggression and psychosis in Alzheimer disease. Cochrane Database of Systematic Reviews 2006; 1: CD003476.Google Scholar
Schneider, L. S., Dagerman, K. and Insel, P. S. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry 2006; 14:191–210.Google Scholar
Ballard, C. G. and Howard, R. Neuroleptic drugs in dementia: Benefits and harm. Nature Reviews Neuroscience 2006; 7:492–500.Google Scholar
Ballard, C. G., Hanney, M. L., Theodoulou, M. et al. The dementia antipsychotic withdrawal trial (DART-AD): Long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology 2009; 8:151–7.CrossRefGoogle ScholarPubMed
Cummings, J., Ballard, C. G., Tariot, P. et al. Pimavanserin: Potential treatment for dementia-related psychosis. Journal of Prevention of Alzheimers Disease 2018; 5(4):253–8.Google Scholar
Tariot, P. N, Erb, R., Podgorski, C. A. et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. American Journal of Psychiatry 1998:155:54–61.Google Scholar
Lonergan, E., Luxenberg, J., Colford, J. M. et al. Valproate preparations for agitation in dementia. Cochrane Database of Systematic Reviews 2009; 3:CD003945.Google Scholar
Teri, L., Logsdon, R. G., Peskind, E. et al. Treatment of agitation in dementia: A randomized placebo controlled trial. Neurology 2000; 55:1271–8.Google Scholar
Porsteinsson, A. P, Drye, L. T, Pollock, B. G. et al. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 2014; 311(7):682–91.Google Scholar
Banerjee, S., Hellier, J., Dewey, M. et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): A randomised, multicentre, double-blind, placebo-controlled trial. The Lancet 2011; 378:403–11.Google Scholar
Meehan, K. M., Wang, H., David, S. R. et al. Comparison of rapidly acting intramuscular olanzapine, lorazepam and placebo: A double-blind randomized study in acutely agitated patients with dementia. Neuropsychopharmacology 2002; 26(4):494–504.Google Scholar

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