Process Models to Understand Resident-to-Resident Aggression Among Residents With Dementia in Long-Term Care.

BACKGROUND/OBJECTIVES: Resident-to-resident aggression (RRA) is a prevalent form of interpersonal violence in long-term care (LTC) settings. Research to guide preventive interventions is limited. Using social-ecological and need-driven dementia-compromised behavior perspectives, we sought to generate process models representing common RRA pathways in dementia-specific LTC units. RESEARCH METHODS: We used qualitative focus group methodology involving staff (n = 36) exposed to everyday resident interactions at two urban LTC facilities in Toronto, Canada. Semistructured interviews were audio-recorded and transcribed. Two independent raters coded the transcripts using iterative, constant comparison analytic processes. RESULTS: Two distinct RRA process models in dementia-specific LTC units were developed. Models reflect sequential pathways driven by residents' benign or responsive behaviors and cognitive processing limitations, with escalation points within resident dyads or groups. IMPLICATIONS: This study furthers RRA conceptualization as a process rather than an aggressive event. Models capture unique RRA manifestations in dementia-specific LTC units and entrypoints for prevention or management.