Relationship between environmental factors and responsive behaviours in long-term care homes: a secondary data analysis

OBJECTIVE: Responsive behaviours (eg, wandering, resisting care and verbal abuse) are a continuing issue for staff and individuals living in long-term care (LTC) homes. The LTC environment can influence responsive behaviours and is a factor in determining the quality of life for those living there. The ways in which the quality of the environment might influence responsive behaviours has not been investigated yet. We hypothesised that better quality environments would be associated with reduced rates of responsive behaviours. We used a tool that simultaneously encompasses human and structural elements of the environment, a novel approach in this field of research. DESIGN: Cross-sectional study, using data collected from September 2014 to May 2015 as part of the Translating Research in Elder Care research programme. SETTING: A representative, stratified (size, owner-operator model and health region) random sample of 76 LTC homes in British Columbia, Alberta, Manitoba. PARTICIPANTS: 13 224 individuals (67.3% females) living in participating LTC homes. OUTCOME MEASURES: Quality of care unit work environment was assessed using the observable indicators of quality (OIQ) tool. Responsive behaviours were assessed using routinely collected Resident Assessment Instrument-Minimum Data Set V.2.0 data. RESULTS: Adjusted regression coefficients of overall Aggressive Behaviour Scale score and interpersonal communication were 0.02 (95% CI −0.011 to 0.045), grooming 0.06 (95% CI −0.032 to 0.157), environment-basics 0.067 (95% CI 0.024 to 0.110), odour −0.066 (95% CI −0.137 to −0.004), care delivery −0.007 (95% CI −0.033 to 0.019), environment-access −0.027 (95% CI −0.062 to 0.007), environment-homelike −0.034 (95% CI −0.065 to −0.002) and total OIQ score 0.003 (95% CI −0.004 to 0.010). CONCLUSIONS: We found small associations between the environmental quality and responsive behaviours in Western Canadian LTC homes. Higher scores on homelikeness were associated with decreased responsive behaviours. Higher scores on basic environmental quality were associated with increased responsive behaviours.