Columbia Killing Points To Rise In Nursing Home Strife

August 31, 2009|By Don Markus | Don Markus,

Earl Wilder was suffering from Alzheimer's disease when he moved to Harmony Hall a year ago. The retired transit worker and World War II veteran got a room on the upper floor of the Columbia assisted-living facility, a section reserved for residents requiring the most intensive supervision.

When Wilder showed he was able to care for himself, he was moved to the general population area of Maryland's largest assisted-living home.

"He was viewed not to be a risk to himself or others," said Harmony Hall general counsel Joe LaVerghetta.

That changed on Aug. 17, when Wilder, 87, positioned his wheelchair close to another resident, 91-year-old James Brown, who was sitting on a bench near the facility's main entrance. Employees said it was around 4 p.m. when Wilder, a former boxer, got out of his chair and began pummeling Brown with his fists. Brown was unable to fend off the attack with his cane, and died six days later.

Wilder, charged with second-degree murder and assault, is being held at a private hospital and has not been arrested, according to authorities.

The beating death, Howard County's first homicide this year, has cast light on the little-discussed area of violence among residents of nursing homes and other institutions. It is a problem that geriatric experts predict will become more prevalent as the aging population grows in Maryland and elsewhere.

"This type of resident-on-resident aggression is substantially more common than previously thought," said Dr. Karl Pillemer, a Cornell University gerontologist who has conducted studies on the subject. "While they are mentally impaired, they are not physically impaired. They can do considerable damage."

Aggression among the elderly is a "big problem," said Arnold Eppel, former head of Baltimore County's Department of Aging and now executive director of an assisted-living facility in Owings Mills. "The first thing that goes is their inhibitions. It can be dressing inappropriately, or hitting."

An estimated 50 percent of those now 85 and older suffer from Alzheimer's or other forms of dementia. The mental diseases are "our next epidemic," Eppel said.

'All kinds of signs'

With the number of Americans 65 and older expected to rise to 71.5 million by the year 2030 - when they will make up 20 percent of the population - the potential for these type of confrontations will continue to escalate, experts say.

Adult facility operators say they try to curb violent incidents. At Harmony Hall, staff members check up on residents of the 251-unit facility "four or five" times a day, according to Louis Grinnel, who as director of Lorien Health Systems has run Harmony Hall since it opened in 1982. Grinnel said about a half-dozen residents are removed from the facility each year when officials fear they may hurt themselves or others.

"Shy of having someone move into their apartment, I think the way we have it here affords us the most opportunity to see the resident on a daily basis, seven days a week," Grinnel said. "There are all kinds of signs that an issue is going on and we are very much attuned to that. I don't see any reason for us to change because this has gone undetected."

In most cases, confrontations are sudden and come without warning, as appears to be the case at Harmony Hall, experts said.

"My belief is that in most instances, it's unprovoked," said Dr. Peter Rabins, a psychiatry professor at Johns Hopkins Bayview Medical Center and authority on dementia. "Something that is nonthreatening is perceived as threatening."

Eppel has seen such situations firsthand. Soon after becoming executive director of Atrium Village, he had to summon Baltimore County police to respond to a potentially violent resident.

The man, who had moved in only five days before, had become combative after being told to take his medication. His erratic behavior, including taking a karate stance, startled staff members and fellow residents.

"He didn't show any of these signs when he had been interviewed by one of our nurses during the screening process," Eppel said. In his mid-60s and suffering from early signs of dementia, the man eventually calmed down after police arrived but was removed permanently from the facility.

According to Rabins, who co-authored "The 36-Hour Day," a guide for families dealing with members suffering from Alzheimer's, homicidal acts are "very rare" by octogenarians with dementia. But showing some sort of aggression is not.

Studies have also shown that men with dementia are more likely to be aggressive than women.

In one of the Cornell studies, a dozen nurses observed 30 episodes of resident-on-resident aggression in a single eight-hour shift at an assisted-living facility, including 17 that were considered physical in nature.

"It is very difficult for any facility to entirely prevent these episodes from happening," Pillemer said.

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