similar risk factors for individual residents. For example, Burgess and her colleagues argued, “The risk for abuse increases simply as a function of their dependence on staff for safety, protection, and care” (Burgess et al., 2000). They found that a diagnosis of Alzheimer’s or other dementia or some type of memory loss or confusion was present at a somewhat higher rate among nursing home residents who had been sexually abused than among the average nursing home population, although those data were from a small case study (Burgess et al., 2000). Similarly, the findings from another study suggest that residents with behavioral symptoms, such as physical aggressiveness, appear to be at higher risk for abuse by staff (Pillemer and Bachman-Prehn, 1991), a finding supported by focus group interviews with CNAs (Hawes et al., 2001) and studies of precipitating factors among community-dwelling elders who have been abused (Pillemer and Suitor, 1992; Ehrlich, 1993).

Unfortunately, dependence on others for help with physical functioning and impairment in cognitive functioning are common among the vast majority of nursing home residents, and difficult or challenging behaviors are not uncommon, as displayed in Table 14-1. These behaviors are often a product of neurological changes, memory loss, and communication deficits associated with diseases such as Alzheimer’s. However, many staff members often view aggressive resident behaviors or attempts to resist care as intentional attempts by the resident to be difficult or to hurt staff, a belief