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May 5, 2004

Aggressive Behaviors and Injuries Among Nursing Home Residents

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(17):2074. doi:10.1001/jama.291.17.2074-c

To the Editor: Dr Shinoda-Tagawa and colleagues1 reported that among residents of nursing homes, those who sustained physical injuries were more likely to be cognitively impaired, exhibit symptoms of wandering, be verbally abusive, have socially inappropriate behavior, or to live on an Alzheimer disease unit. Although we appreciate these findings, we are concerned that the authors' use of "violent incidents" rather than "injury" in the title implies a perpetrator, and thus the possibility of "blaming the victim." Similarly, the authors attributed risk factors to individuals, rather than to aspects of the nursing home environment. This approach tends to isolate individuals as problematic2 and lead to their stigmatization.3 By contrast, environmental interventions and protective pathways may be effective in addressing the underlying structural problems.4 Furthermore, profiling based on a minimum data set may have the unintended consequence of making placements more difficult for stigmatized residents even as the report cards attempt to "ensure(s) the dignity of each resident."5

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