Types of Nursing Home Residents with Self-destructive Behaviours: Analysis of the Harmful Behaviours Scale

Objective: To investigate the types of self-destructive behaviours identified by the Harmful Behaviours Scale (HBS) and the variables associated with them.

Method: A cross sectional survey involving 647 residents in 11 nursing homes in the eastern suburbs of Sydney, Australia. The following instruments were used: Harmful Behaviours Scale (HBS); Behavioural Pathology in Alzheimer's Disease Rating Scale; Functional Assessment Staging Scale; Resident Classification Index; Health of the Nation Outcome Scale; Even Briefer Assessment Scales for Depression; Abbreviated Mental Test Scale; and the suicide item from the Structured Hamilton Depression Rating Scale. Diagnosis of dementia was obtained from nursing home records.

Results: Latent class analysis of the HBS identified four groups of residents, described as 'aggressive resistant' (34.9%), 'food refusal' (26.8%), 'behaviourally disturbed' (5.4%) and a 'non-symptomatic' group (33.0%) with little self-destructive behaviour. The behaviourally disturbed group engages in a widespread combination of direct and indirect self-destructive behaviours and displays other behavioural and psychological symptoms of dementia. In contrast, the food refusal group whose only behavioural symptom was refusal to eat and drink had the most cognitive impairment and did not show higher levels depression or suicidal ideation.

Conclusions: We have found three groups of residents with self-destructive behaviours and each group is associated with a different pattern of variables.