International Psychogeriatrics


Non-pharmacological interventions for aggressive behavior in older adults living in long-term care facilities

Philippe Landreville a1c1, Annick Bédard a1, René Verreault a2, Johanne Desrosiers a3, Nathalie Champoux a4, Johanne Monette a5 and Philippe Voyer a6
a1 School of Psychology, Université Laval, Québec, Canada
a2 Department of Social and Preventive Medicine, Université Laval, Québec, Canada
a3 Research Centre on Aging, Sherbrooke Geriatric University Institute, and Department of Family Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada
a4 Montreal Geriatric University Institute, Montréal, Canada
a5 Division of Geriatric Medicine, Centre for Clinical Epidemiology and Community Studies, Solidage: McGill/Université de Montréal Research Group on Integrated Services for Older Persons, Jewish General Hospital, McGill University, Montréal, Canada
a6 Laval University Geriatrics Research Unit and Faculty of Nursing Sciences, Université Laval, Québec, Canada

Article author query
landreville p   [PubMed][Google Scholar] 
bedard a   [PubMed][Google Scholar] 
verreault r   [PubMed][Google Scholar] 
desrosiers j   [PubMed][Google Scholar] 
champoux n   [PubMed][Google Scholar] 
monette j   [PubMed][Google Scholar] 
voyer p   [PubMed][Google Scholar] 


Background: Aggressive behavior (AB) is common in institutional settings. It is an important issue because of its consequences on both the person manifesting such behaviors and their caregivers. Although there are numerous studies assessing non-pharmacologic strategies to manage AB in older adults, no extensive review of the literature is available. This review synthesizes the current knowledge on the effectiveness of non-pharmacological interventions in institutional settings.

Method: Papers describing the assessment of a non-pharmacological intervention to manage AB in which participants were at least 60 years old and living in a long-term care facility were selected mainly by searching various databases.

Results: A total of 41 studies were identified and included in the review. These studies mainly use quasi-experimental designs and include less than 30 participants. Sixty-six percent (27/41) of the studies report either a statistically or behaviorally significant reduction of AB as a result of a non-pharmacological intervention. Staff training programs and environmental modifications appear to be the most effective strategies.

Conclusion: Non-pharmacological interventions seem effective for managing AB. Future studies on the effectiveness of these interventions need to be more rigorous. Development in this field needs to be based on knowledge regarding the determinants of AB in older adults.

(Received December 21 2004)
(returned for revision March 16 2005)
(revised version received June 16 2005)
(Accepted June 17 2005)

Key Words: patient assault; treatment; treatment outcomes; nursing homes; residential care institutions; homes for the aged.

c1 Correspondence should be addressed to: Philippe Landreville, School of Psychology, Université Laval, Québec, QC, G1K 7P4, Canada. Phone: +1 418 656 2131, ext. 3024; Fax: +1 418 656 3646. Email: