Rage and fear in nursing homes

The Norwegian newspaper Aftenposten published a rather unsettling article in its A-magazine this weekend about violence within elderly care centers/nursing homes in Norway. At first glance, I thought it would be about abuse of elderly residents by nursing home employees. This is not unheard of, and has been written about for a number of years now. No, this article was about abuse of elderly residents and nursing home caregivers by fellow elderly residents, and it is more widespread than one might think. The nurses and care workers do not report all of the incidents that occur, hence this type of violence is under-reported. Many of the violent residents have been diagnosed with dementia, and even though they are cognitively-challenged, they still retain their physical strength and their voices, both of which they use against their fellow residents and the caregivers. In some cases, the violence was directed against visitors, who ended up terrified. Most of the violence has to do with the rage some of these residents feel, most likely rage against their illness, their mental incapacity, the fact that they know they are in a nursing home and perhaps feel like prisoners, their sense of having lost their identity--the list is long. The point is that their dementia makes them angry, makes them rage, makes them act out, and when they do, much of it takes the form of physical violence, but also verbal abuse (yelling and swearing). Some of these residents throw glasses, cups, chairs; others hold others down, slap them, punch them, kick them, bite them, spit at them, and try to break the fingers of the care workers. Still others (men) were sexually abusive toward some of the elderly women living in the homes. In most cases, the care centers and nursing homes were understaffed, especially at night when some of the demented residents wandered through the halls and into and out of other residents' rooms. It is up to the residents to decide if they want to lock their doors or not; the nursing homes cannot make this decision for them without their permission unless violent situations such as described in the article arise. These situations cannot lead to any repercussions in terms of prison sentences either, since demented individuals cannot be prosecuted.

Any way you look at it, this is an impossible situation. If employees and non-violent residents end up terrorized by violent residents in nursing homes, it will not end well for anyone. I can envision a not-to-distant future where few to no young people will choose to work as nurses or aides in nursing homes. The number of elderly with dementia is predicted to double by 2050, thus need for round-the-clock care will only increase. I don't know what the future holds, but I do know that if something is not done to tackle the problem, it will not go away. I don't know what the policies are for tranquilizing such people, but it might be one way to proceed in order to keep them calm. I don't know how elderly with dementia are currently treated (with drugs), but at least if they are tranquilized they cannot be a danger to themselves or others. I know it sounds harsh, but the alternatives are harsher. If nursing homes end up being more understaffed than they are now, they will close, and then it will be up to individual families to take care of these violent demented individuals (most of whom were men in the Aftenposten article, but there were some few women). I feel sorry for them, but they cannot be allowed to destroy the peace that the non-violent elderly deserve after a long life. The latter deserve respect and the right to live out their lives in peace and without fear of being harassed or physically assaulted by fellow residents or anyone else. I applaud Aftenposten for raising this issue, which is most difficult to discuss and even more difficult to solve.

Apparently, this is a global problem, as I have seen online. In other countries, there are special nursing homes for elderly with severe (and aggressive) dementia. Anger is a part of dementia, and in other countries tranquilizers are often prescribed for such people. But they do not always take their medications. So it remains a problem--how to deal with these elderly, how to respect them but at the same time limit their aggression, and how to protect the non-violent residents and caregivers.