PHYSICAL AGGRESSION IN THE MENTALLY ILL ELDERLY

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This project is designed to examine how physical aggression in the elderly mentally ill impacts patients, program and staff, and policy in the public sector mental health system. Assaultive geriatric patients may account for 7% of all geriatric clients in the public sector mental health system, but 20% of all the elderly admitted to state hospitals. Preliminary evidence suggests that assaultiveness in these clients is highly correlated with the presence of organic system. Such patients are much more likely than nonviolent elderly to have a record of multiple admissions. Existing treatment appears to be minimally effective, and discharge is very difficult because of the lack of suitable placement facilities. There is a reasons to believe that the number and percentage of such clients is growing and will continue to expand into the next century. Despite the seriousness of the situation, there is almost no empirical database available on the problem or on potential solutions to it. The current project is designed to collect and compile four data sets that will be most useful in assessing the implications of assaultive behavior for geriatric patients, programs and staff, and system policy, as well as defining parameters for ameliorative action at each of these three levels of impact. In collaboration with the Colorado Division of Mental Health, data sets will be assembled to include: (1) detailed computerized archives for nine years from Colorado, (2) treatment and outcome data from chart records in Colorado state hospitals for four years, (3) longitudinal data for one year at colorado state hospitals that will include staging of dementia and recording of factors concomitant with specific assaultive incidents, and (4) archival Colorado state hospital records for nine years covering staff injuries due to assaults. Altogether, analysis of the data sets will permit a study of the clinical and treatment profiles for these clients, an assessment of correlates of onset and treatment outcomes as well as impact on program and staff, and implications for current and potential system policies.