The most prolific perpetrators of elder abuse may be living among them
1. The most prolific perpetrators of elder abuse may be living among them
At least 1 in 5 nursing home residents may have experienced abuse by other residents
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Researchers studying the prevalence of resident-to-resident mistreatment in nursing homes found that at least one in five elderly residents had experienced some form of verbal or physical mistreatment from other residents during a one-month surveillance period. The findings are published in Annals of Internal Medicine.
Resident-to-resident elder mistreatment is a recognized problem in nursing homes but well-designed studies of its prevalence are lacking. Having a better understanding of this type of abuse and its causes could help to inform the development of effective prevention strategies.
In the first large-scale, systematic study of its kind, researchers surveilled five urban and five suburban New York state nursing homes during a one-month period to estimate the prevalence of resident-to-resident mistreatment. Mistreatment was classified as any "negative and aggressive physical, sexual, or verbal interaction between long-term care residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient." The incidents of mistreatment were identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports.
During surveillance, at least 20 percent of nursing home residents experienced resident-to-resident mistreatment. Verbal aggression was the most common form of mistreatment, but the rate of physical aggression between residents was substantial, and several episodes of sexual aggression were also seen during the study timeframe. The authors noted that one of the most compelling findings was that the traditional focus of violence mitigation in the nursing home — staff abuse of residents — may be disproportionate relative to the actual parties involved in the incidences of mistreatment.
Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, please contact John Rodgers at [email protected] or 212-821-0597.
2. TKIs associated with increased risk for cardiovascular events in patients with chronic myeloid leukemia
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Patients taking tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) face an increased risk for arterial and venous vascular events. The findings are published in Annals of Internal Medicine.
CML is a type of cancer that starts in certain blood-forming cells of the bone marrow and is triggered by the BCR-ABL1 fusion gene. It is a slow growing form of leukemia that usually targets older adults. However, without treatment, CML generally progresses to a fatal form of acute leukemia in only a few years. TKIs, which target the BCR-ABL1 fusion gene, have increased survival dramatically for patients with CML, but continuous administration of these drugs may elicit long-term toxicity.
Researchers sought to determine the incidence of vascular events in patients with CML treated with first-generation TKIs (imatinib) and second-generation TKIs (nilotinib or dasatinib). The researchers used a Swedish registry of patients diagnosed with CML between January 2002 and December 2012 and matched each patient by birth year and sex to 5 control individuals randomly selected from Sweden's Total Population Register. The data showed that patients taking TKIs for CML had a greater risk for arterial and venous thrombotic events compared to the general population. The researchers observed a greater risk for myocardial infarction among patients treated with a second-generation TKI compared with those on a first-generation therapy, but the number of events was too small to allow statistical comparison. Further study is needed to determine whether the risk for myocardial infarction increases with second-generation drugs. The authors suggest that clinicians consider this risk for vascular events when initiating TKI therapy in patients with CML.
Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, Dr. Torsten Dahlén, please contact the Karolinska University Hospital Solna press office at [email protected]
Also new in this issue:
ClinicalTrials.gov and [email protected]: A Comparison of Results Reporting for New Drug Approval Trials
Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS; Eugene Zheng, BA; Tony Tse, PhD; and Deborah A. Zarin, MD
Research and Reporting Methods
The CMS Sepsis Mandate: Right Disease, Wrong Measure
Michael Klompas, MD, MPH, and Chanu Rhee, MD, MPH
Ideas and Opinions