Training Programs for Dementia Care Staff and Aggression in Nursing Homes: Secondary Analysis of a Cross-Sectional...

Training programs help dementia care staff handle residents' behavioral symptoms in nursing homes and assisted living facilities. However, it is unclear how feeling well-prepared from such training relates to experiences of physical and verbal aggression from residents.

This study aimed to determine whether perceived training preparedness was related to experiences of physical and verbal aggression from residents in nursing homes and assisted living facilities using data from a large, nationally representative dementia care workforce sample.

This study was an analysis of the 2024 National Dementia Workforce Study, a cross-sectional online survey of the national dementia care workforce. Weighted regression modeling was used to identify associations between feeling well-prepared by training programs and experiencing physical or verbal aggression.

Dementia care staff in nursing homes (weighted n=896,320) commonly reported experiencing physical (365,452/896,320, 40.8%) and verbal (470,536/896,320, 52.5%) aggression from residents with dementia, whereas more than two-thirds (614,561/896,320, 68.6%) reported feeling that their training prepared them well to manage resident behaviors. Staff in assisted living facilities (n=738,856) less commonly reported experiencing physical (198,964/738,856, 26.9%) and verbal (223,343/738,856, 30.2%) aggression, whereas almost three-quarters (527,621/738,856, 71.4%) reported feeling that their training prepared them well to manage resident behaviors. In regression modeling in nursing homes, feeling well-prepared by training for managing resident behaviors was associated with a lower likelihood of experiencing physical aggression (odds ratio [OR] 0.4, 95% CI 0.223-0.711; P=.01) and verbal aggression (OR 0.5, 95% CI 0.299-0.844; P=.02). In assisted living facilities, feeling well-prepared by training for managing resident behaviors was associated with a lower likelihood of experiencing physical (OR 0.14, 95% CI 0.04-0.55; P=.01) and verbal (OR 0.07, 95% CI 0.0134-0.354; P=.001) aggression.

While physical and verbal aggression from residents with dementia is common in nursing homes and assisted living facilities, nationally representative weighted regression modeling highlights an association between feeling well-prepared to handle resident behaviors and a lower likelihood of experiencing aggression. As the data used were derived from a cross-sectional survey, the causal link between these 2 factors should be explored in interventional studies. Our results indicate that effective training programs are associated with worker-reported reduced experiences of physical and verbal aggression in both nursing homes and assisted living facilities. The specific components of training programs that may support effectiveness remain unknown.