Thursday, December 29, 2011

Violence in our twilight years

 In a horrible story of husbands and wives facing health issues.

Police continue to search for details in stabbing death of woman, 82

 Ottawa man charged with killing wife at seniors' home 
Ian Flann wheeled into hospital room to hear charges 
CBC News Posted: Dec 28, 2011 2:48 PM ET

Ian Flann (82) was took his wife back and forth between doctors' appointments over the years and neighbours said Ian's health had recently deteriorated. After complications from surgery Doreen Flann (82) was moved into the Longfields Manor Retirement Home. Friends said Ian visited often, but the visits were tense because his wife was suffering from dementia and often couldn't recognize him. Unfortunately, many a retirement home cannot cope with dementia clients.

Revera Inc is a private company categorized under Extended Care Facility and located in Mississauga, ON, Canada. It was established in 2007 according to Current estimates show this company has an annual revenue of $995,013,120 and employs a staff of approximately 25,000. 

Longfields is owned by Mississauga-based Revera Inc., which has more than 250 facilities across Canada and the U.S. and serves about 30,000 clients.

Violence in long-term care is a terrible issue.

A CBC new article states: More than a dozen people have died violently inside Canadian nursing homes during the past decade.
That doesn't seem like a lot to me. Not that one is too many.

We need to look at the facts. Violence in long-term care (LTC) occurs frequently enough that there must be better training for those who may pose a risk to themselves and to others. Murder is not the norm. But those with dementia lose the ability to control their tempers. They may be frustrated and unable to communicate, have left their family and their home. Staff must be trained and must be given the tools (human, physical and financial) to help them do their work.

Nursing Home Violence  :  White Coat Black Art

 A study (see below) from Laval University published in 2005 found that more than one in five older residents at long-term care facilities act aggressively.

CBC News Investigation (2007) documented a rapid increase in violent attacks in nursing homes in that province. Between 2003 and 2006, the number of violent incidents among residents of long-term care facilities increased from 446 to 1,416.

Now, reported family violence in society has remained at 6%, according to Statcan for 2004 and 2009.

Younger Canadians were more likely to report being a victim of spousal violence than were older Canadians. Those aged 25 to 34 years old were three times more likely than those aged 45 and older to state that they had been physically or sexually assaulted by their spouse. Family violence against seniors tends to be lower compared to younger age groups. The rate for seniors in 2009 was less than half that for adults aged 55 to 64 and more than eight times lower than the rate for adults aged 25 to 34.

There is violence in many workplaces, especially when people are ill and vulnerable.

Hospital violence strikes nurses' aids the most

And the least trained bear the brunt of it all.

A national survey of nearly 19,000 nurses found a staggering 29.6 per cent of nurses working in a hospital said they were physically abused by a patient over the past 12 months, according to the 2005 study done by the Canadian Institute for Health Information, Health Canada and Statistics Canada.

Take paramedics: A study of 1,381 paramedics 
  • 26.1 per cent had been physically abused, with 92.3 per cent reporting that patients were responsible for these attacks.

A 2005 inquest into a double murder at the Casa Verde Nursing Home in Toronto produced 85 recommendations [PDF].
  • Better behavioural assessments, specialized units for aggressive residents, more nursing care, training and funding.
  • If a resident is placed in a nursing home and the resident turns out to "have a complexity of care, such as aggressive behaviours, that cannot be safely managed," there should be a mechanism in place to quickly transfer the resident to a facility that has the capabilities to care for the resident.
(In other words, staff must speak truth to power, and admit that they cannot cope with a particular client.)
  • The Ministry of Health and Long-Term Care should fund specialized facilities, as an alternative to long-term facilities, to care for demented or cognitively impaired residents exhibiting aggressive behaviour. The facilities should be designed using the model of the Dorothy Macham Home at Sunnybrook and Women's College Health Science Centre to meet the physical and staffing requirements of these high-need residents. 
We need a continuum of care. No question. Severe cognitive impairment is a predictor of violence. Agressive behaviour occurs also with chemical and physical restraints. It is imperative that staff be highly trained in this area.

Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities
Philippe Voyer1*René Verreault2Ginette M Azizah1Johanne Desrosiers3Nathalie Champoux4 and Annick Bédard5 BMC Geriatrics 2005, 5:13 doi:10.1186/1471-2318-5-13

The same percentage of older adults displayed physical aggressive behaviour (21.2%) or verbal aggressive behaviour (21.5%), whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical) were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia.

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