Relational Aggression in Assisted Living Facilities: Insights Into An Underrecognized Phenomenon

Background/purpose: Relational aggression (RA), defined as non-physical aggression intended to hinder the development of friendships and social acceptance, has long been recognized as a problem among youth in educational settings. RA has surprisingly been noted to occur among older adults in senior housing and senior care organizations as well. However, little is understood regarding how this phenomenon manifests in late-life, and research evidence for developing effective interventions is unavailable. To begin rectifying this knowledge gap, authors present findings from a pilot project that represents one of the first studies to examine RA among older adults. Focused on assisted living settings, the study’s purpose was to ascertain residents’ perceptions regarding peer interactions that are most distressing and the impact of such interactions on emotional well-being. Research aims also included identifying characteristics that differentiate residents who experience high levels of RA-related distress from those who experience lower levels of distress.

Method: The study employed a mixed methods design that included semi-structured interviews combined with standardized measures of resident characteristics, including cognition, mood, self-esteem, and trauma history. The purposive sample included 30 residents in two assisted living facilities who self-identified as experiencing problematic interactions with their peers. The sample included 20 men and 10 women whose ages ranged from 60 to 83. Two participants were African American and the remaining participants were Caucasian.

Interviews centered on residents’ perceptions regarding distressing peer interactions and the emotional impact of such interactions. Residents’ cognitive status was measured via the Montreal Cognitive Assessment instrument, mood status was measured via the short form Geriatric Depression Scale, self-esteem via Rosenberg’s Self Esteem Scale, and history of trauma by a modified version of the Life Events Checklist.

Thematic analysis was utilized to identify primary themes in residents’ narratives and was guided by a theoretical coding approach that stemmed from the research questions. The sample was dichotomized into residents who reported high levels of distress and those who reported low levels of distress; independent samples t-tests were conducted to assess differences across the standardized measures by RA-related distress.

Results: Distressful social interactions included derogatory name-calling, gossiping, domineering, invasion of privacy or space, and persistant harassment for money or cigarettes. Unexpectedly, residents also voiced considerable anguish regarding peers who exhibited disruptive psychiatric symptoms and tended to label these individuals as bullies. Exposure to RA contributed to self-isolation, pervasive fearfulness and anxiety, and exacerbation of existing mood disorders. Residents reporting higher levels of RA-related distress had more depressive symptoms (p < .10) and lower self-esteem (p < .05) compared to their counterparts reporting lower distress.

Conclusions/Implications: Residents viewed any frightening behavior as synonymous with bullying. Depression and low-self esteem were associated with feelings of emotional distress associated with experiencing RA. Potentially promising strategies to minimize RA may include psychoeducation aimed at enhancing understanding of mental illness. Furthermore, identifying and treating underlying depression and bolstering residents’ self-esteem may help build resilience in coping with the challenges of communal living.