Training Programs for Dementia Care Staff and Aggression in Nursing Homes: Secondary Analysis of a Cross-Sectional Online Survey.

Background: Training programs help dementia care staff handle residents' behavioral symptoms in nursing homes and assisted living facilities. However, it is unclear how feeling well-prepared from such training relates to experiences of physical and verbal aggression from residents. Objective: This study aimed to determine whether perceived training preparedness was related to experiences of physical and verbal aggression from residents in nursing homes and assisted living facilities using data from a large, nationally representative dementia care workforce sample. Methods: This study was an analysis of the 2024 National Dementia Workforce Study, a cross-sectional online survey of the national dementia care workforce. Weighted regression modeling was used to identify associations between feeling well-prepared by training programs and experiencing physical or verbal aggression. Results: Dementia care staff in nursing homes (weighted n=896,320) commonly reported experiencing physical (365,452/896,320, 40.8%) and verbal (470,536/896,320, 52.5%) aggression from residents with dementia, whereas more than two-thirds (614,561/896,320, 68.6%) reported feeling that their training prepared them well to manage resident behaviors. Staff in assisted living facilities (n=738,856) less commonly reported experiencing physical (198,964/738,856, 26.9%) and verbal (223,343/738,856, 30.2%) aggression, whereas almost three-quarters (527,621/738,856, 71.4%) reported feeling that their training prepared them well to manage resident behaviors. In regression modeling in nursing homes, feeling well-prepared by training for managing resident behaviors was associated with a lower likelihood of experiencing physical aggression (odds ratio [OR] 0.4, 95% CI 0.223-0.711; P=.01) and verbal aggression (OR 0.5, 95% CI 0.299-0.844; P=.02). In assisted living facilities, feeling well-prepared by training for managing resident behaviors was associated with a lower likelihood of experiencing physical (OR 0.14, 95% CI 0.04-0.55; P=.01) and verbal (OR 0.07, 95% CI 0.0134-0.354; P=.001) aggression. Conclusions: While physical and verbal aggression from residents with dementia is common in nursing homes and assisted living facilities, nationally representative weighted regression modeling highlights an association between feeling well-prepared to handle resident behaviors and a lower likelihood of experiencing aggression. As the data used were derived from a cross-sectional survey, the causal link between these 2 factors should be explored in interventional studies. Our results indicate that effective training programs are associated with worker-reported reduced experiences of physical and verbal aggression in both nursing homes and assisted living facilities. The specific components of training programs that may support effectiveness remain unknown.