A Staff Intervention Targeting Resident-to-Resident Aggression in Assisted Living: A Cluster-Randomized Trial.

Overview

abstract

BACKGROUND: Resident-to-resident aggression (RRA) in long-term care settings is widespread with the potential for serious detrimental outcomes. However, few evidence-based training, intervention, and implementation strategies exist. The objective was to evaluate intervention process outcomes (knowledge), and proximal and distal outcomes (increased recognition, documentation, and reporting) in assisted living facilities. METHODS: Staff reported on RRA with respect to 930 residents (495 intervention and 435 usual care) from 14 New York assisted living facilities (7 per group). Data were collected at baseline, 6 and 12 months. Intervention site staff received training, while usual care staff did not. Knowledge outcomes were measured using two 10-item scales. Recognition and documentation for care planning were measured on an ongoing basis in real time, and longitudinal reporting of past two-week events through a structured interview. Mixed models were used to evaluate continuous knowledge variables. Outcome evaluation was conducted on an intent-to-treat basis using Poisson regressions for longitudinal count data measuring recognition/documentation and reporting. RESULTS: A total of 238, 263, and 217 staff attended Modules 1-3, respectively. There was a statistically significant increase in knowledge post-training, controlling for pre-training levels (estimated mean = 1.37, 95% CI, 1.11-1.62, p < 0.001 for Module 1 and estimated mean = 0.46, 95% CI, 0.21-0.70, p < 0.001 for Module 2). The program statistically significantly increased recognition and documentation of RRA in real time (estimated log mean = 4.34, 95% CI, 1.22-7.45, p = 0.006); there were 92 incidents reported by intervention group staff as contrasted with one in the usual care group. In terms of longitudinal reporting of events using a structured interview, a significant between-group difference was observed (estimate = 0.64, 95% CI, 0.18-1.09, p = 0.006). CONCLUSIONS: The training intervention was demonstrated as effective in enhancing knowledge, recognition/documentation, and reporting of RRA in assisted living, replicating findings in nursing homes. It is recommended that this program be disseminated in long-term care facilities. TRIAL REGISTRATION: Clinical Trials.gov identifier: NCT03383289 registered December 26, 2017. The first subject was enrolled May 26, 2018; the last subject was enrolled August 2022; follow-up data collection was completed June 5, 2023.