Just how challenging can older people be? Part 2: Making the case for specialist services for risky and aggressive behaviour

Abstract

Objectives:The myth that elderly patients are not challenging permeates the image of older adult services, yet a growing literature suggests aggressive behaviour amongst this population exists. The Overt Aggression Scale-Modified for Neurorehabilitation (OAS-MNR) is a means of measuring aggressive behaviour amongst people with acquired brain injury (ABI) and similarities in ABI and elderly patients indicate that the OAS-MNR may be useful within the latter. The utility of the OAS-MNR was evaluated.Method:All overt aggression over three months was recorded using the OAS-MNR, including the frequency, severity and antecedents to aggression as well as staff interventions in an in-patient setting.Results:The data captured 2753 episodes of aggression, adding to the prevalence literature. Indeed, the severity of aggression was comparable with ABI populations. Physical aggression against others was most frequently observed, followed by verbal aggression. The majority of the incidents followed agitation or distress, no obvious antecedent, or a direct verbal prompt. Staff predominantly responded with ‘less intrusive’ interventions. These data are also considered according to neurological versus forensic groups of patients.Conclusion:It is suggested that the OAS-MNR could be used effectively to guide service provision for with valuable feedback to patients, staff, relatives and purchasers.