A protocol for responding to aggression risk in residential aged care facilities

Abstract

Objective: To propose a provisional protocol which organises the existing knowledge base into a set of simple procedural guidelines to support residential aged care staff to respond in a consistent and effective manner when faced with situations where aggression is perceived to be imminent, ideally preventing aggressive behaviours from eventuating. Background: Aggressive behaviours by older adults in aged care facilities have the potential to cause significant physical and psychological harm, particularly for other residents. Staff are increasingly discouraged from managing such behaviours with restrictive practices such as physical and/or pharmacological restraint. Instead, staff are encouraged to intervene before an incident takes place, using interventions that reduce the everyday risk of aggression, as well as those that are implemented when aggression is perceived to be imminent. However, for this to be implemented in a meaningful way, staff must be equipped with the knowledge, skills, and resources to intervene in ways that are respectful and effective. Developing a protocol for responding to imminent risk of aggression by organising the existing knowledge base into a set of straightforward guidelines would support staff to implement preventative strategies in a consistent and effective manner. Study design and methods: A traditional/narrative literature review was undertaken to critique and synthesise previously published research to identify research that might be relevant to the construction of guidelines for responding to the risk of imminent aggression. Discussion: This paper proposes a provisional protocol, consisting of a series of interventions for preventing aggression in residential aged care facilities: daily monitoring; de-escalating the situation; identifying and addressing situational triggers, providing an immediate therapeutic intervention, and considering medication. This protocol is necessarily provisional in nature and is intended to be further developed through theoretical critique, expert opinion, consumer feedback, and empirical evaluation. Implications for research, policy, and practice: Research in four areas would improve the ability of staff to intervene in a preventative manner: (1) developing and validating a daily monitoring tool that would allow staff to identify when aggression is imminent; (2) continuing to build a methodologically sound body of evidence to support the use of specific primary and secondary preventative interventions; (3) understanding whether the causes and processes underlying aggressive behaviour by older adults with dementia differ from those without dementia; and (4) determining whether preventative interventions are equally effective for different groups within this population. What is already known about the topic? Verbal and physical aggression by older adults in residential aged care facilities can cause serious harm to residents and staff. A wide variety of approaches to managing imminent risk of aggression in older adults have been proposed, but there is limited empirical evidence to guide staff in choosing the best approach. What this paper adds: An integrated summary of the factors known to influence risk of aggression in older adults. A proposed protocol for managing imminent risk of aggression that organises the known literature into a set of clear, specific directions for staff.