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ASSESSMENT OF AGGRESSIVE BEHAVIOR TRIGGERS Back to Course Index

Regardless of what and where it comes from aggression needs to be diffused and fast.  Learning to de-escalate a situation before it is too late must include training on recognizing where, when and in what environment to watch for it.  Culture and gender play a role in aggression.  American men resorted to physical aggression more readily than Japanese or Spanish men, whereas Japanese men preferred direct verbal conflict to their American and Spanish counterparts. Within American culture, southerners were shown to become more aroused and to respond more aggressively than northerners when affronted. 

Aggression is often an escalation of a disturbed behavior triggered by a range of contributing factors, including:

  • Clinical conditions (e.g. mental health illness, brain disorder, intellectual disability and cognitive impairment)
  • Undesired interpersonal interactions
  • Personally interpreted stress
  • Environmental disturbances (e.g. noise, confined space).

The most important role in regards to assessment is to identify the contributing factors, to understand why aggression is occurring and to treat the underlying cause(s) or condition(s). A common cause of aggression in older people is their misinterpretation of the environment and miscommunication, where aggressive behavior is often triggered by fear.

On-going engagement with the patient and their family through clear, respectful and open communication allows early detection, identification and appropriate management of triggers that may lead to aggressive behavior. Where necessary, input should be sought from staff who have expertise and knowledge in identifying precursors to aggressive behavior during the clinical risk assessment, as part of a multidisciplinary approach to the care of the patient. When a disturbed behavior occurs, do not enter the patient’s / individual’s personal space without their permission (unless there is an immediate risk of self-harm or harm to others) as this could escalate their distress, anger and / or behavioral disturbance.

 

Key points to note:

1. Engage with the patient, their family and other health professionals (using a team approach) to identify stressors/ triggers for disturbed behavior as part of the initial and ongoing patient care. 

2. Undertake appropriate clinical assessment to obtain information on the patient’s condition. For example, cognitive screening tools for older persons, medical assessment of mental health patients and Drug and Alcohol assessment tools.

3. Develop ways to manage stressors / triggers of disturbed behavior and document a management plan for health care teams to follow.