Resident-to-resident aggression (RRA) in long-term care (LTC) is associated with preventable injury, suffering, and serious psychological distress. One in five residents in nursing homes (NH) experiences RRA in a given month. Residents with Alzheimer's Disease and Related Dementias (ADRD) are at an even higher risk of RRA due to cognitive impairment-related symptoms. However, RRA remains poorly understood. The race and ethnicity of residents may play an important role in RRA initiation and escalation, risk/resilience factors, consequences, and NH response systems. As NH populations are becoming increasingly racially/ethnically diverse, focusing on the role of race/ethnicity in RRA allows for the development of a tailored prevention and intervention to identify and address it, as many residents involved in RRA have ADRD and are unable to speak for themselves. The goal of this equity-driven project is to systematically investigate the role of race/ethnicity in the types, patterns, and circumstances surrounding RRA using the first prevalence cohort study of RRA, and collecting additional stakeholder input with explicit consideration of the needs of residents with ADRD, to develop, refine, and pilot-test a novel intervention. In Aim 1, I will leverage the first and only NIH-funded RRA prevalence cohort study to qualitatively contextualizing and quantitatively examining the role of race/ethnicity in RRA across individual, dyadic, and facility levels. Aim 2, I will gather input from multiple NH stakeholders to improve understanding of the role of race/ethnicity in RRA, and to identify current and optimal intervention and prevention strategies in residents with and without ADRD via mixed methods approach. In Aims 3a and 3b, findings from Aim 1 and Aim 2 will be used to develop and refine a staff education intervention focused on the role of race/ethnicity in RRA that may be integrated into an existing RRA intervention program that does not currently have information regarding race/ethnicity. As a social scientist trained in public health research, I am ideally positioned to spearhead this line of research, given my productive track record in social determinants of health and elder mistreatment research. Through the award period, I will build upon my prior training to develop new knowledge and skills in long-term care research (Aim 1; Training Objective 1); health equity research (Aim 1; Training Objective 2); long-term care policy-making, advocacy, and leadership (Aim 2; Training Objective 3); and behavioral intervention and implementation science (Aim 3a, 3b; Training Objective 3). Career development activities will consist of formal coursework, experiential learning and research opportunities, and mentorship from experts in elder mistreatment, RRA research, health disparities, and behavioral intervention development. This award will help me achieve my long-term career goal of being an independent investigator with an impactful program of long-term care research focused on equity-driven, evidence-based elder abuse prevention and intervention development and implementation for racially/ethnically diverse older persons with ADRD.

PROJECT NARRATIVE Resident-to-resident aggression (RRA) is a prevalent issue in long-term care with severe health consequences to residents, many of whom suffer from Alzheimer's Disease and Related Dementias (ADRD) and are minority racial/ethnic backgrounds. We propose to comprehensively examine the role of race and ethnicity in RRA using already existing prospective prevalence data, in addition to collecting nursing home stakeholder input to improve understanding of the role of race/ethnicity in RRA to inform a novel staff education RRA intervention development. This proposal thus has the potential to reduce race/ethnicity-related RRA, strengthen workforce training by improving provider competency for resolving race and ethnicity-related aggression among residents, and benefit residents with ADRD from diverse racial/ethnic backgrounds who are at higher risk of RRA involvement due cognitive impairment related behavioral symptoms.