Inquiries have commenced regarding the death of a 90 year-old man following a fight in a dementia ward in Wollongong on Tuesday.

Police were called to a nursing home facility in Woonona just before 7pm following reports of an altercation between two residents in their high-dependency dementia ward.

Upon arrival, police were notified that the 90 year-old man had suffered serious injuries and was unable to be revived.

The second man who was involved in the tragedy, aged 77, is a resident of the high-dependency ward due to his dementia diagnosis.

While details regarding the circumstances that lead to the man’s death are currently vague, this is actually not the first instance in which a resident has died following an altercation at the IRT Wanoona nursing home.

Mervyn Campbell, 84, died three days after being attacked in his bed by a resident welding a wedge-shaped wooden door-stopper in July 2012.

Why?

While a sense of shock surrounding these tragic circumstances is understandable, incidents of resident-to-resident aggression can become commonplace in facilities that house elderly residents who are living with dementia.

Resident-to resident aggression is an umbrella term that includes physical,verbal or sexual interactions that are considered to be negative, aggressive or intrusive.

These behaviours can result in a number of negative outcomes ranging from psychological distress through to serious physical harm resulting in death.

While the exact statistics regarding the prevalence of resident-to-resident incidents is difficult to determine, research from the US estimates that at least 20% of nursing home residents are involved in these types of incidents and that the true number is probably significantly higher.

These types of incidents typically arise between residents with a cognitive impairment or diagnosis of dementia, and often transpire during the afternoon period where the behavioural and psychological symptoms known as ’sundowning’ often occurs.

A high number of resident-to-resident incidents are unprovoked or triggered by communication issues stemming from cognitive or physical impairment.

And those who exhibited aggression towards other residents were often younger and more recently admitted to their nursing homes than their targets.

The Fallout

Incidents like this are accompanied by numbness that is not apparent in all tragedies.

The symptoms associated with dementia can have a devastating effect on a person’s mental capacity and can render them incapable of being responsible for their own actions.

The result of which can be individuals behaving and committing acts that contradict the morals and reputation that took them a lifetime to build.

These people were often stable, hardworking and good natured in their younger years, resulting in the families of the assailants often feeling conflicted as to who their loved one is, and was, after an incident of this magnitude.

The family of the victim on the other hand, face a reality that seems almost impossible to digest. Losing a loved one is difficult enough, but losing the loved one in a violent manner at the hands of another person is something completely different.

In average cases of serious assault and murder, the assailant can be used as an outlet for families to vent emotions and place blame, but in these types of incidents, the attacker may not have been responsible for their own actions and there can be a lack of criminal intent.

This can place the families of the victims in the unusual place position of grieving for the loss of a loved one while simultaneously feeling the need to sympathise with attacker in order to justify what has occurred.

The fallout from these types of incidents is not solely reserved for the families of the residents involved though, as a number of aged care workers forge strong relationships and bonds with residents and feel an emotional impact similar to the families of the residents involved.

Those working at the time of an incident can often shoulder a large portion of guilt relating to serious incidents that occur and can also be a point of blame for the families involved, despite the lengths that they go to in order to provide quality care.

What Can Be Done?

The unpredictable nature of the symptoms associated with dementia can make incidents of resident-to-resident aggression extremely difficult to preempt.

Since 2008 laws have put the onus on the provider to report serious incidents of resident-to-resident aggression to the department of health, but there are currently loopholes within this legislation that allow providers to forgo incident reporting if a behavioural plan is put in place within 24 hours of the incident.

Professor Joseph E Ibrahim, Head of the Health Law and Ageing Research Unit, told HelloCare that he believes that the lack of reporting and information is hindering the process to find answers.

“Reporting needs to be more consistent, and all serious incidents need to be reported, otherwise we won’t be able to get the information that we need to change practice,” he said.

“Even the information that is held by government isn’t available to the sector, and we have not seen a report that describes the total number of incidents and what these incidents consisted of.”

“What would be interesting would be to see information on the last year or 5 years if possible so we are able to see what patterns exist and figure out what we can do as a sector.”

When questioned as to why he believed the government would not make this type of information readily available, Professor Ibrahim had more questions than answers.

“I raised that point at the House of Representatives Inquiry and I don’t have an answer, so I don’t know, but the normal principles of practice in a sector like healthcare is that this information is available to view and learn from.”

The image used to illustrate this article is a stock image and does not depict any actual persons or events described in the article.

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