| Physical assaultiveness against caregivers is an especially disturbing disruptive behavior occurring in older persons with Alzheimer's disease and related disorders (ADRD). The personal care activity most associated with physical assaults is bathing. The overall purpose of this study was to increase the understanding of how, why, and under what circumstances physical assaults occur among nursing home residents with ADRD, and to identify factors and cues that predict an impending assault. The specific aims of the study were: (1) to determine whether overall resident agitation was associated with assaultive behavior; (2) to evaluate whether specific actions of the caregivers or characteristics of the physical environment predicted the onset of physical assaultive behaviors; and (3) to develop an explanatory model of assaultive behavior that takes into account the joint effects of multiple factors.;As part of a larger study, 73 residents with ADRD and agitation during bathing were recruited within 15 nursing homes. The 188 baseline bathing videotapes of routine bathing activities were coded as assaultive and non-assaultive. In addition, resident psychological/emotional state, caregiver actions, and physical environment were coded and analyzed using The Observer Video-Pro, a computerized behavior observation software package. Mixed model analysis, lag sequential analyses and Generalized Estimating Equations (GEE) were used as analytic methods. Overall agitation levels were greater among assaultive than non-assaultive baths (p ≤ 0.001). Fist clenching and verbal threats by the residents were more common in assaultive baths (p ≤ 0.001). Lag sequential analyses identified the following caregiver behaviors to precede one or more assaultive behaviors by ≤5 seconds (p ≤ 0.001): Negative communication, invalidation, disrespectful speaking, restraint, any touch, hurried speed of bath, calling resident by name, praise/encouragement, restraint, and simple instruction. Environment factor, crowding, also preceded assaults (p ≤ 0.01). In addition, the following bathing activities preceded an assault: spraying water without verbal prompt, hair washing, touching/washing axilla or perineum (p ≤ 0.01). An explanatory model using GEE displayed those multiple resident and caregiver factors influencing assaultive behavior.;This study improves the understanding of the antecedents and consequences of assaultive behaviors in nursing home residents with ADRD. Findings imply the need to consider multiple factors in the design and individualization of interventions. |
