Risk Factors and Risk Assessments for Violence in Residential Long-Term Care: A Scoping Review

In long-term residential care, power imbalances and care-related stressors may create conditions for violence, which occurs in multiple directions and can take various forms. Both residents and staff may be affected as victims or perpetrators, particularly in contexts shaped by cognitive impairment, organizational constraints, or interpersonal stress. Despite its prevalence and complexity, systematic evidence on structured, institution-level risk assessment approaches remains limited. This scoping review therefore investigates recommendations for facility-specific risk assessments to prevent violence and identifies risk factors for violence in residential long-term care settings. Searches were conducted in MEDLINE via PubMed, CINAHL via EBSCO, and the Cochrane Library. Grey literature was also included. Eligible publications addressed institutional risk factors or described the validation or application of risk assessment tools in long-term care settings. The search adhered to Joanna Briggs Institute guidelines, with data extraction and analyses based on consensus among three reviewers. A total of 64 articles were included, with 3 focusing on the validation of risk assessments and 61 describing risk factors for violence in long-term care. Eleven risk analyses from major residential long-term care providers were identified, of which four domains for risk factors were deduced: (a) work organization and facility structures, (b) residents, (c) staff, and (d) building aspects. There is a need for evidence-based risk assessment strategies in long-term care settings. These should address identified risk factors through staff training, organizational support, and resident care strategies.