Major Finding: Among 16 focus groups made up of 103 residents and staff, 18% of the groups and 38% of participants reported witnessing sexually aggressive behavior in a nursing home setting.
Data Source: Analysis of focus group answers to questions at single, large, not-for-profit skilled nursing facility.
Disclosures: Tony Rosen, a medical student and researcher, had no relevant disclosures.
ORLANDO – Sexually aggressive behavior might be common between nursing home residents, according to a focus group study.
Most sexual aggression against older adults occurs in long-term care facilities rather than in community settings, according to previous case series. “Very little direct research exists [regarding] what we've begun to call RRSA or resident-to-resident sexual aggression,” said Tony Rosen, who conducted the research within the division of geriatrics and gerontology of Cornell University, New York.
Fellow residents are the most common perpetrators of sexually aggressive behavior, not nursing home staff, as sometimes reported in the media, Mr. Rosen said at the annual meeting of the American Geriatrics Society.
Among 103 participants in 16 focus groups including nursing home employees and some residents, 38% of participants in 18% of the focus groups reported having witnessed sexually aggressive behavior.
Inappropriate touching was the most commonly reported behavior in the study, mentioned in 38% of focus groups by 7% of participants. Residents attempting to get into the bed of another (13% of groups and 18% of participants) and verbal sexual abuse (13% of groups and 5% of participants) were the next most frequent incidents reported.
A behavior cited in the focus groups that surprised the researchers was inappropriate caregiving, mentioned in 6% of groups and by 3% of participants. “Inappropriate caregiving is residents trying to give intimate nursing care to other residents, a phenomenon we did not expect,” Mr. Rosen said.
The focus groups included 7 cognitively intact residents and 96 clinical and nonclinical employees from all three shifts at a single, large, not-for-profit long-term care facility. The descriptions of witnessed sexually aggressive behavior came from a larger focus group study evaluating overall resident-to-resident verbal and physical aggression.
“Prevention and management [of these behaviors] are more challenging due to legitimate and increasingly recognized need for sexual expression by nursing home residents,” said Mr. Rosen, a medical student at Cornell.
Mr. Rosen and his colleagues defined RRSA as “negative sexual interactions between long-term care residents, that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient.” Consequences for residents include sexually transmitted diseases, agitation, and posttraumatic stress disorder, he said.
Focus group facilitators used semistructured, open-ended interview questions. Average focus group time was 45 minutes.
The researchers also elicited reasons or triggers for RRSA. For example, a resident mistaking another for his or her spouse was reported by 13% of groups and 8% of participants. Cognitive impairment and wandering each were cited as reasons in 13% of groups and by 5% of participants.
“This is a very challenging issue,” Mr. Rosen said. “And sexual aggression can be a very charged topic.” He recommended that these behaviors be studied and understood in the context of brain disease and agitation-related behaviors.
Resident rooms were the setting for the sexually aggressive behavior mentioned by 13% of groups and 2% of participants. Similarly, nursing home dining rooms were mentioned by 13% of groups and 1% of participants. Somewhat surprisingly, Mr. Rosen said, 6% of groups and 3% of participants also said they saw sexual aggression in main lounges or television viewing areas.
Mr. Rosen made no relevant financial disclosures.
Management of these behaviors is complicated because residents have a need for sexual expression.
Source MR. ROSEN