Constipation Linked to Aggression in Nursing Home Residents

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Constipation Linked to Aggression in Nursing Home Residents

http://www.medpagetoday.com/PrimaryCare/Geriatrics/dh/3666

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of

Pennsylvania School of Medicine.

June 30, 2006

MedPage Today Action Points

* Explain to relatives of nursing home residents that this study

associates constipation with outbreaks of physical aggression.

Review

ST. LOUIS PARK, Minn., June 30 — Constipation can trigger physical

aggression in a nursing home resident with dementia, researchers here

reported.

In a large group of residents with dementia, those with constipation

were about as likely to exhibit aggressive physical behavior as those

who experienced hallucinations, said Ralph Leonard, M.D., M.P.H., of the

medical software company CALM-MD here.

" To our knowledge no prior studies have investigated the association of

constipation, " Dr. Leonard and colleagues said in the June 26 issue of

Archives of Internal Medicine. " We chose to study constipation a priori

because it is common, modifiable, and recognized by clinicians to be a

cause of many non-specific symptoms. "

The cross-sectional study also confirmed results of previous studies

that depression, delusions, and hallucinations were linked with

aggressive behavior in nursing home residents with dementia, the authors

said.

Dr. Leonard and colleagues examined records of more than 100,000 nursing

home residents living in California, New York, Ohio, Pennsylvania, and

Texas during 2002. All participants were 60 or older and had dementia.

Data were obtained from the Minimum Data Set, a health assessment that

must be completed for all residents of facilities that receive federal

funds.

Nearly 7% of the residents had been physically aggressive-defined as

hitting, shoving, scratching, or engaging in sexual abuse-in the week

before their assessment. Furthermore, 10.5% of residents had been

verbally aggressive-threatening, screaming, cursing-the week before

their assessment.

The study could not determine whether aggression had been directed at

fellow residents, visitors, or staff.

After adjusting for factors such as age, sex, and degree of cognitive

impairment, the investigators found that following were linked with

physical aggression:

* Depression (odds ratio=3.3; 95% confidence interval=3.0 to 3.6)

* Delusions (OR=2.0; 95% CI=1.7 to 2.4)

* Hallucinations (OR=1.4; 95% CI=1.1 to 1.8)

* Constipation (OR=1.3; 95% CI=1.2 to 1.5)

Similarly, the following were linked with verbal aggression, although

for constipation the results only bordered on statistical significance:

* Depression (OR=4.9; 95% confidence interval=4.5 to 5.3)

* Delusions (OR=2.5; 95% CI=2.2 to 2.8)

* Hallucinations (OR=1.6; 95% CI=1.3 to 1.9)

* Constipation (OR=1.1; 95% CI=1.0 to 1.2)

" It is not clear whether physical aggression may be related to factors

that predispose to constipation (e.g., anticholinergic medications such

as tricyclic antidepressants), the symptoms associated with

constipation, or interventions such as suppositories that may elicit a

defensive action by some residents, " the researchers said.

" We found that aggressive behavior among residents was associated with

depression, delusions, and hallucinations, and that physical aggression

was also associated with constipation, " they said. " All of these factors

may be amenable to intervention and, in addition to reducing the

morbidity associated with these entities themselves, effective treatment

may reduce the risk of violence in nursing homes. "

The study did not find significant associations with factors one might

expect to underlie aggressive behavior, such as respiratory tract

infections, urinary tract infections, fever, or reported pain, the

investigators said.

The authors pointed out that " because this was a cross-sectional

observational study and the Minimum Data Set does not specify a sequence

of onset for outcome and exposure variables, we cannot assert a temporal

link between resident characteristics and either physical or verbal

aggression. "

Primary source: Archives of Internal Medicine

Source reference:

Ralph Leonard et al. " Potentially modifiable resident characteristics

that are associated with physical or verbal aggression among nursing

home residents with dementia. " Archives of Internal Medicine 2006;

166:1295-1300.

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