Self-destructive behaviors in nursing home residents

To validate the Harmful Behaviors Scale (HBS) as a measure of direct and indirect self-destructive behaviors in nursing home residents and to determine the prevalence of self-destructive behaviors and their relationship to other variables.

A cross-sectional study.

Eleven nursing homes in the eastern suburbs of Sydney, Australia.

Six hundred ten nursing home residents aged 65 and older.

Instruments used were the HBS, Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale (FAST), Even Briefer Assessment Scale for Depression (EBAS-Dep), and the suicide item from the structured Hamilton Depression Rating Scale. Data on diagnoses of dementia, depression, or psychotic disorder; prescription of psychotropic medication; and demographics were obtained from nursing home records.

On the HBS, indirect harmful behaviors occurred at least weekly in 61% of subjects, and direct harmful behaviors occurred in 14% of subjects. The HBS total score was significantly positively correlated with the BEHAVE-AD score (Pearson's r=0.679, P <.001) but not with the EBAS-Dep "wish for death" item and total score. HBS scores were significantly higher in residents scoring greater than zero on the Hamilton suicide item (F=1.380, df=3,325, P=.249). Stepwise multiple linear regression indicated that younger age, chart diagnosis of dementia, greater incapacity as measured by FAST, and a higher Hamilton suicide item score predicted a higher HBS total score.

Self-destructive behaviors are common in nursing home residents and are mostly related to dementia. There was little evidence of a relationship between depression and self-destructive behaviors.