Aggressive behavior in nursing home residents and the call for antipsychotics

Type opdracht: Ma

In –of extern?: Intern

Meerdere studenten mogelijk? Nee

Zelf data verzamelen? Ja

Type onderzoek: kwantitatief


Dementia is often complicated by manifestations of neuropsychiatric symptoms. Dutch guidelines recommend non-pharmaceutical psychosocial interventions as first-line treatment for neuropsychiatric symptoms. However, antipsychotics are very often prescribed as treatment for these symptoms. Prescribing antipsychotics is becoming highly controversial, because of their association with serious adverse events and modest effectiveness. Research has shown that physicians often feel pressured by the nurses and caregivers to prescribe drug treatment for the residents.

Nurses and caregivers spend a lot of time with the residents and they are also expected to know about the risks of drug treatments. However, they are the persons at high risk of being subjected to violence by the residents with dementia [1]. In his study Isaksson [1] et al reports that 68% of caregivers working in nursing homes had been exposed to violent behavior during the previous year. Behavioral and psychological symptoms of dementia (BPSD) [2] are common among residents suffering from dementia, occurring up to 80% of the patients during the course of the disease [3]. Those symptoms are often associated with different types of violence, such as physical, verbal and sexual violence.

Violence often complicates nursing care. Especially in the morning or in the evening when the caregiver is required to work in close contact with the resident giving personal care, e.g. helping the resident with meals and personal hygiene, the caregivers are at risk being involved in violent situations [4]. So far, most research focused on the prevalence of violence in various types of care settings and in relation to factors, such as participants’ diagnoses, gender and caregivers’ characteristics. However, few studies have explored how physical health care is managed by health care staff. Furthermore, it is unclear how the nurses and caregivers confidence or loss of control over the situation in managing aggressive behavior affects the nurses call for antipsychotics.

It is unclear if nurses really ask physicians for prescribing antipsychotics. If they do ask for those drugs, why are those needed? Do nurses not feel confident enough to use other measures or are they unaware of other measures?

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Begeleider: Eerste begeleider is nog niet bekend, in ieder geval Jeannette van Manen (GZW) als 2e tweede begeleider



Isaksson, U., et al., Physically violent behaviour in dementia care: Characteristics of residents and management of violent situations. Aging & Mental Health, 2011. 15(5): p. 573-579.


Finkel, S.I., et al., Behavioral and Psychological Signs and Symptoms of Dementia: A Consensus Statement on Current Knowledge and Implications for Research and Treatment. International Psychogeriatrics, 1997. 8(SupplementS3): p. 497-500.


Zuidema, S., et al., Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry, 2007. 22: p. 632 - 638.


Åström, S.S.Å.G.M.A.B.-I., Staff's experience of and the management of violent incidents in elderly care. Scandinavian Journal of Caring Sciences, 2004. 18(4): p. 410-416.