Table 3.

Common reasons / triggers for resident-to-resident aggression seen by staff and resident focus group participants (n=16 groups, 103 participants)

Reasons / Triggers Mentioned*	%of Groups Mentioning	% Participants Mentioning†	Total Conversation Blocks Mentioning‡	Representative Dialogue
Calling Out / Making Noise	88%	51%	43	Medical Staff #2: …So then when one’s calling out, screaming, or whatever, the other one’s cursing the other one out. “Shut up,” and, you know- Medical Staff #5: "Get out of here." Medical Staff #2: Yeah, more and more to that effect. And then it becomes just like a big circus in the nurses station.
Territoriality / Challenges with Communal Living	75%	39%	25	Activities #5: And when they think they’re always sitting in that chair, that is their chair and if somebody sits in there—“That’s my chair” and they own their chairs and if somebody’s sitting there and doesn’t want to move, that person can be physically abusive because I have seen one person when she pick up her walker—Miss ___ on the 12th floor— she pick her chair--her walker and just—thank God, at that moment I was passing by and so I was able to stop it. But if nobody’s there, who will stop that, you know?
Roommate inability to compromise preferences	69%	36%	25	Housekeeping #10: Simple things do it. Like if you live in a double room, and one neighbor don’t like her TV loud, the next neighbor like her TV loud- Housekeeping #6: That’s where the fight occurs. Housekeeping #9: Yes, it’s a big issue. They can’t compromise, they can’t do nothing. Just argument, and- Housekeeping #6: The air conditioner. They fight over the air conditioner. It’s too cold for her. And this other person-- Housekeeping #10: One wants the window up. One don’t want it up
Impatience	63%	32%	21	Housekeeping #6: But see, when they wanna go by, you know, sometimes the resident is a little slow, if the person behind is faster, they have no patience. Housekeeping #9: Yeah, they’re impatient. They’re impatient. Housekeeping #6: Pushing them. Housekeeping #10: Really bad attitudes. Housekeeping #9: Yes. Housekeeping #10: “Hurry up, get out of my way, move.” You know, in other words they don’t like this person.” So, therefore, they have less patience.
Loneliness / Abandonment / Frustration with Institutionalization	63%	28%	17	Nurse - evening shift #3: I think it’s just frustrations for life. Nurse - evening shift #3: Because it’s a different lifestyle. They have different--now we have residents who really lived life. They traveled…they will have money, etc. And then some think they can manage themselves they’re in here. And everything gets below that level of expectations. So that’s what starts… Nurse - evening shift #3: They cannot live the life that they did before. Nurse - evening shift #1: They cannot accept. Nurse - evening shift #1: Accept that they’re here and just that’s frustrations comes.[agreement] CNA - evening shift #6: …Mrs. ___, her husband come every day. And sometimes the husband ain’t able to come…She scratch her eyes out when she realize her husband not coming, her husband don’t come yet, and she’s very agitated.
Jealousy	50%	26%	16	CNA – day shift #1: They get jealous. They get jealous. CNA – day shift #11:…when he see me attending to another resident, he says “Come. Come. Come. Come.” CNA – day shift #7:…If I am paying attention to -- like helping the next resident and he’s right there, he want all the attention from me that I should come to him ‘cause I’m not paying him any attention. CNA – day shift #14:..My resident yells at the other resident. She’s telling her to “You shut up. Shut up.” The other one says: “No, you shut up.” They’ll be arguing back and forth
Dementia / Cognitive Impairment / Disinhibition	50%	18%	11	Social Worker #3: Well, I had another incident this week with two residents who have dementia. ..And they happened to be sitting next to each other in the dining room. And the one resident with dementia always likes to have like—if she is sitting near somebody, she likes to reach out. And she’ll touch their hand. You know, she is always kind of reaching out. If you pass her in the hall, she is reaching out for you as well. She wants to be touched. And she happened to be sitting next to another gentleman in the dining room who also has dementia. She reached out to touch his hand, and he just bent it backwards.

^*The reasons / triggers most commonly mentioned by focus groups are displayed in this table. Reasons / triggers displayed here are ordered based on the number of focus groups mentioning, then number of participants mentioning, then number of conversation blocks. Additional reasons / triggers mentioned by focus group participants included: Challenges Communicating / Different Languages / Hearing Problems, Congestion in Public Areas during Resident transit, Racism / Ethnic Stereotyping / Religious Issues, Intolerance of More Physically Dependent Residents, Perceptions or Accusations of Theft, No Apparent Trigger / Rapid Mood Change, Intolerance of Cognitively Impaired, Confused Residents, Personal animosity / picking fights, Inappropriate Caregiving, Competition for Bathroom, Wandering, Difficulty Adjusting to Facility, Full Moon, Spousal Identity Confusion, Fatigue after long day, Boredom / Lack of Activities, Loss of Personal Space in Adjustment to Communal Living, Loud Music, History of Being Abused Earlier in life, Loss of Routine, Inability to Concentrate / Short Attention Span, Intoxication. A total of 29 reasons / triggers were identified from the focus groups.

^†These participants may have directly mentioned this reason / trigger or have participated in a conversation wherein it was mentioned.

^‡Focus groups were divided into conversation blocks where participants were discussing a specific resident or theme. The conversation blocks which addressed specific reasons / triggers were counted and those counts are displayed here.