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  • Writer's pictureMichelle Shank

Dementia Residents and Workplace Violence

An important topic to acknowledge and address are the risk factors associated with working in a long term care facility. The residents most likely to commit violence on workers are patients that have some form of cognitive impairment.

We have a lot of checks and balances and protocols to protect our elders. We also need to focus on ensuring that our workers in long term care facilities are also well protected. 

34% of patients with moderate dementia show aggressive behavior when living in long-term care facilities. 27% of all workplace violence happens in nursing homes. Patients in the later stages of dementia are more likely to physically attack a worker as opposed to verbal attacks. This creates a sensitive and dangerous environment for LTC workers. Some of these attacks can come without warning.

Causes of Aggression

First, determine and understand what is triggering the aggression. A resident with dementia can show signs of aggression because of

  • Separated from family

  • Isolation

  • Unfamiliar surroundings

  • Coping with illness

  • Medication side effects

  • Not getting enough rest

  • Over stimulated

  • Loss of ability to communicate

  • Pain levels may be high

  • Medical issue such as UTI

Understanding the cause is beneficial for the resident and the staff. Don’t just look at the aggressive act but take time to figure out the root cause. Once you determine the root cause, then it may be possible to make adjustments.


CNA’s have the most interaction with patients putting them at a higher risk for workplace violence from a resident. It’s important to implement a behavioral management skills training program. Studies have shown that behavioral education helps reduce patient agitation and improved communication skills.

Being aware of the signs of a resident’s behavior is important. If you notice a slight shift in behavior there may be some ways to calm the resident before they get too upset. 

Discovery. Trying to narrow down the causes for the aggression can help lessen the violent outbursts. Try to discover why they are agitated. 

Positive. Try to stay positive and reassuring. 

Distract. Introduce a calming activity such as music to help calm them down.

Assistance. Once you have the resident calm, it’s okay to walk away and report to their supervisor. If the resident continues to escalate, always call for help.

Behavior management techniques can be effective when the proper training and support is provided. 

  • Assessing to ensure the resident is not over stimulated

  • Learning how to reorient the resident

  • Utilize simple one step directions

  • Always assess for slight changes in behaviors

  • Be patient and give the resident ample time to complete tasks

Eventually, over time behavior management may no longer be as effective. Have a team plan in place ready and ready to implement. This team should consist of family, nursing, CNA, physician, and a dementia care specialist. 

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