Self-destructive behaviors in nursing home residents

OBJECTIVES: To validate the Harmful Behaviors Scale (HBS) as a measure of direct and indirect self-destructive behaviors in nursing home residents and to determine the prevalence of self-destructive behaviors and their relationship to other variables. DESIGN: A cross-sectional study. SETTING: Eleven nursing homes in the eastern suburbs of Sydney, Australia. PARTICIPANTS: Six hundred ten nursing home residents aged 65 and older. MEASUREMENTS: Instruments used were the HBS, Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale (FAST), Even Briefer Assessment Scale for: Depression (EBAS-Dep), and the suicide item from the structured Hamilton Depression Rating Scale. Data on diagnoses of dementia, depression, or psychotic disorder; prescription of psychotropic medication; and demographics were obtained from nursing home records. RESULTS: On the HBS, indirect harmful behaviors occurred at least weekly in 61% of subjects, and direct harmful behaviors occurred in 14% of subjects. The HBS total score was significantly positively correlated with the BEHAVE-AD score (Pearson's r = 0.679, P <.001) but not with the EBAS-Dep "wish for death" item and total score: HBS scores were significantly higher in residents scoring greater than zero on the Hamilton suicide item (F = 1:380; df = 3,325, P = .249). Stepwise multiple linear regression indicated that younger age, chart diagnosis of dementia, greater incapacity as measured by FAST, and a higher Hamilton suicide item score predicted a higher HBS total score. CONCLUSIONS: Self-destructive behaviors are common in nursing home residents and are mostly related to dementia. There was little evidence of a relationship between depression and self-destructive behaviors.