Relationship between environmental factors and reactive behaviors in long-term care homes: an analysis of secondary data


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BMJ Open. October 11, 2021; 11 (10): e047364. doi: 10.1136 / bmjopen-2020-047364.


OBJECTIVE: Responsive behaviors (eg, wandering, resistance to care, and verbal abuse) are an ongoing problem for staff and people living in long-term care (LTC) homes. The LTC environment can influence responsive behaviors and is a determinant of the quality of life of the people who live there. The ways in which the quality of the environment might influence reactive behaviors have not yet been investigated. We hypothesized that better environments would be associated with reduced rates of responsive behavior. We used a tool that simultaneously encompasses the human and structural elements of the environment, a novel approach in this field of research.

DESIGN: Cross-sectional study, using data collected from September 2014 to May 2015 as part of the Translating Research in Elder Care research program.

BACKGROUND: A representative, stratified random sample (size, owner-operator model, and health region) of 76 LTC homes in British Columbia, Alberta and Manitoba.

PARTICIPANTS: 13,224 people (67.3% women) living in participating LTC homes.

MEASUREMENT OF RESULTS: The quality of the work environment of the care unit was assessed using the Observable Quality Indicators (OIQ) tool. Responsive behaviors were assessed using data from the Resident Assessment Instrument Minimum Data Set V.2.0.

RESULTS: The adjusted regression coefficients of the Aggressive Behavior and Interpersonal Communication scale overall score were 0.02 (95% CI -0.011 to 0.045), grooming 0.06 (95% CI – 0.032 to 0.157), environmental basics 0.067 (95% CI 0.024 to 0.110), odor -0.066 (95% CI -0.137 to -0.004), caregiving -0.007 (95% CI -0.033 to 0.019), access to environment -0.027 (95% CI -0.062 to 0.007), home environment -0.034 (95% CI -0.065 to -0.002) and total OIQ score 0.003 (95% CI -0.004 to 0.010 ).

CONCLUSIONS: We found small associations between environmental quality and responsive behaviors in LTC homes in Western Canada. Higher scores on sense of belonging were associated with a decrease in responsive behaviors. Higher scores on baseline environmental quality were associated with increased responsive behaviors.

PMID:34635514 | DO I:10.1136 / bmjopen-2020-047364

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