Exploring the Role of Race and Ethnicity in Resident-to-Resident Aggression: A Qualitative Study

Resident-to-resident aggression (RRA) is the most common form of elder mistreatment in long-term care settings. Although race/ethnicity is likely a contributing factor, research has been limited in examining the role of residents' race and ethnicity in RRA. We sought to define and qualitatively examine the predisposing factors and acute precipitants of race/ethnicity-related resident-to-resident aggression (RE-RRA).

Guided by the socioecological model, events-based perspective, and conceptual work on stigma-based aggression, we developed qualitative interview and data analytical guides. We conducted nine focus groups and twelve in-depth interviews with 81 nursing home staff from multiple clinical and non-clinical roles across two long-term care facilities on the U.S. East Coast. We coded qualitative data using a deductive thematic qualitative approach.

RE-RRA appeared to be a recurring interpersonal dynamic, though its full scope is likely under-detected and under-recognized. We identified five major types of RE-RRA, including physical violence, microaggression, social exclusion, and avoidance. Ten predisposing factors and eight acute precipitants uniquely contributed to RE-RRA, highlighting the importance of considering distinct race- and ethnicity-related elements in prevention research. We summarized our findings in a conceptual framework for RE-RRA that may be useful for future research.

RE-RRA is a distinct phenomenon shaped by identifiable predisposing and precipitating factors, offering opportunities for future prevention and intervention development. These findings underscore the importance of integrating RE-RRA within staff education, existing clinical governance structures, including incident reporting, and quality improvement processes.