Process Models to Understand Resident-to-Resident Aggression Among Residents With Dementia in Long-Term Care

Resident-to-resident aggression (RRA) is a prevalent form of interpersonal violence in long-term care (LTC) settings. Research to guide preventive interventions is limited. Using social-ecological and need-driven dementia-compromised behavior perspectives, we sought to generate process models representing common RRA pathways in dementia-specific LTC units.

We used qualitative focus group methodology involving staff (n = 36) exposed to everyday resident interactions at two urban LTC facilities in Toronto, Canada. Semistructured interviews were audio-recorded and transcribed. Two independent raters coded the transcripts using iterative, constant comparison analytic processes.

Two distinct RRA process models in dementia-specific LTC units were developed. Models reflect sequential pathways driven by residents' benign or responsive behaviors and cognitive processing limitations, with escalation points within resident dyads or groups.

This study furthers RRA conceptualization as a process rather than an aggressive event. Models capture unique RRA manifestations in dementia-specific LTC units and entrypoints for prevention or management.