This paper takes a close look at how often care workers in Swiss nursing homes face aggression from residents, whether it’s verbal, physical or sexual, and what might influence those incidents. Using data from 155 nursing homes, 402 units and just under 4,000 care staff, the authors asked participants to recall any aggressive episodes over the previous four weeks. They then dug into how factors like staffing levels, type of unit, work environment and personal characteristics (age, gender, levels of exhaustion) link to the odds of experiencing aggression.

Background

Aggression in long-term care can show up as swearing and threats, hitting or hair-pulling, and even unwanted sexual advances. Smaller studies have blamed everything from dementia severity and low staff-to-resident ratios to poor leadership and worker burnout, but we’ve never had a big, representative look at all these angles in one go. The Swiss Nursing Homes Human Resources Project (SHURP) aimed to fill that gap by studying the prevalence of three aggression types, paired with both organisational conditions and individual staff traits.

Methods

Study Design

This was a secondary analysis of SHURP, a cross-sectional survey carried out in 2012–13.

Who Took Part

• 155 nursing homes (≥20 beds each) that use Switzerland’s standard long-term care funding

• 402 care units

• 3,919 direct-care workers (all qualifications, at least one month on the job, ≥8 hours/week)

What Was Measured

Aggression: Self-reported frequency of verbal, physical and sexual aggression in the past four weeks (never → several times a day)

Unit & Facility Factors:

• Size (small, medium, large), profit status, language region– Staff ratio (full-time equivalents per 100 beds

• Unit type:
  – Special Care Units (SCUs) for dementia (100% residents with dementia, specialist staff)

  – Non-SCUs with high dementia prevalence (≥60%)

  – Non-SCUs with lower dementia prevalence (<60%)

Work Environment:

• Leadership quality
• Perceived adequacy of staffing & resources
• Autonomy (“I can decide how to do my work”)
• Collaboration with colleagues
• Participation in decisions (six survey items)

Care Worker Traits:

• Age, gender, education level (RN, licensed practical nurse, certified assistant, aide, other)
• Emotional exhaustion (frequency of feeling drained after work)

Resident Profiles (unit averages):

• Age
• Length of stay
• Care-need level
• Dementia prevalence

Results

How Common Is Aggression?

• Verbal: 66% of staff reported at least one episode in four weeks
• Physical: 42%
• Sexual: 15%

Most incidents happened less than once a week.

What Drives Verbal Aggression?

• Unit Type: Staff on SCUs had the highest risk. Non-SCUs (both dementia levels) cut the odds by about 75%.
• Staffing & Resources: Feeling well-resourced reduced odds by ~24%.
• Collaboration: Those rating teamwork highly actually reported more verbal aggression—likely because they’re more comfortable reporting it.
• Exhaustion: Each uptick in emotional exhaustion raised the odds by ~24%.
• Age: Every extra year cut the risk by ~1%.

What Drives Physical Aggression?

• Unit Type: SCUs highest risk; non-SCUs around 75% lower odds.
• Staffing & Resources: Again, better perceptions cut risk by ~25%.
• Exhaustion: Each point up added ~15% to the odds.
• Age: Older staff had slightly lower risk.
• Role: Certified assistants and aides faced about 25–30% higher odds than registered nurses.

What Drives Sexual Aggression?

• Unit Type: Non-SCUs had roughly half the risk compared with SCUs.

• Staffing & Resources: Feeling adequately resourced cut odds by ~24%.

• Autonomy: Those with high autonomy had ~25% lower odds.

• Exhaustion: Higher exhaustion linked to ~20% higher odds.

• Age & Gender: Older staff faced less risk. Men had ~40% lower odds than women.

Discussion

• Dementia Units Are Hotspots
  Staff in fully specialised dementia units consistently reported the most aggression. That’s partly the resident mix (higher dementia severity) and possibly staff sensitivity. These units need extra focus on support and prevention.
• Perception Matters More Than Numbers
  Actual staff ratios didn’t predict aggression, but workers’ sense that staffing and resources were sufficient did. If your team feels under-resourced or lacks the right skill mix, stress rises, and aggression follows.
• Autonomy Helps; Collaboration Needs Nuance
  Letting caregivers make on-the-spot decisions cut sexual aggression. Good teamwork seemed to boost verbal reports, likely because people felt safe reporting, not because more aggression really occurred.
• Emotional Exhaustion Is a Red Flag
  Burnout strongly correlated with every kind of aggression. Whether exhaustion causes more incidents or vice versa, the takeaway is clear: support staff wellbeing to keep everyone safer.
• Experience Pays Off
  Older, more seasoned staff enjoyed a small protective effect. That suggests mentoring junior staff in de-escalation and situational awareness could cut incidents.

Conclusion

Aggression against care workers in Swiss nursing homes is widespread. Verbal aggression is most common while sexual is least, but all forms carry risks for staff wellbeing and resident care quality. Key protective factors are working in non-dementia units (but someone must work there, right?), feeling well-resourced, having autonomy, being older or more experienced, and managing exhaustion. Interventions should go beyond simply upping headcounts; they must tackle how staff perceive their workload, boost decision-making freedom, offer strong emotional support, and build a transparent, no-blame reporting culture, especially in dementia-specialised units.

Practical Takeaways for WHS & HR Professionals

1. • Check staffing perceptions, not just ratios

1. • Boost autonomy

1. • Build emotional safety nets

1. • Mentor junior staff

1. • Champion a no-blame reporting culture

1. • Tailor support for dementia units

1. • Monitor wellbeing metrics

1. • Leverage interdisciplinary case reviews

1. • Review policies on sexual aggression

1. • Measure impact & adapt

Citation

Stutte K, Hahn S, Fierz K, Zúñiga F. Factors associated with aggressive behavior between residents and staff in nursing homes. Geriatr Nurs. 2017;38(5):398-405.