Living environment and resident-to-resident aggression in long-term residential care facilities

Living environmental conditions can pose great impacts on the health and well-being of older adults receiving care from residential care facilities (RCFs). Despite the growing concern on resident-to-resident aggression (RRA) worldwide, little is known about what environmental factors, and how these factors affect RRA among RCF residents. This study examined the correlates of RRA, with a special emphasis on the environmental and structural features of the RCFs. Cross-sectional data collected from a quota sample of 412 personal care workers (PCWs) working at 29 RCFs in Hong Kong were analysed using linear mixed-effects modelling. Guided by a survey, PCWs reported the most recent RRA incident they witnessed, and provided details about the perpetrator, victim, and the RCF involved. Effects of different individual characteristics of PCWs and residents, as well as environmental and structural factors of RCFs were included to predict RRA witnessed by PCWs. Results show that RRA is associated most strongly with residents’ behavioural disturbances (perpetrator: B = 0.19, SE = 0.04, p < .001; victims: B = 0.16, SE = 0.03, p < .001). Among all environmental factors, cleanliness of the indoor areas of RCFs is the only significant predictor of RRA ( B = -0.06, SE = 0.03, p < .05). Overall, findings did not support the impacts of most environmental features on RRA in the current settings. Yet, the significant effects of residents’ behavioural disturbances and cleanliness of RCFs on RRA advocate for integrated prevention and intervention strategies that address both individual health needs and organisational management. • Living environment is linked to the likelihood of resident-to-resident aggression (RRA) witnessed by personal care workers (PCWs) in residential care facilities. • Residents living in facilities with clean indoor areas are less likely to experience RRA. • Greater behavioural disturbances of both perpetrators and victims are associated with more severe RRA incidents.