Background To monitor and improve quality of care, all incidents in our nursing home are registered and evaluated. Incidents like aggression, falls, and choking may have serious consequences for the patient involved, for other patients, and staff. Behavioral problems, including aggression may occur in Huntington's disease.

Method A retrospective analysis was made of all reported aggression incidents (verbal and acting) caused by patients with Huntington's disease residing in our 31 bed unit between January 1^st 2007 and December 31^st 2009. Patients residing for less than a month were excluded. We investigated which patients behaved aggressively, and whether their aggression caused harm to others.

Results During this survey, 44 patients (20 women, 24 men) stayed in our unit for at least one month. 334 times aggression was reported. Staff members reported (minor) injuries 18 times. Once a fellow-patients was injured. Frequently, aggression was reported in relation to disputes concerning smoking, and nursing care. Twenty five patients (57%) never, or only once, showed aggressive behavior. A quarter of our patients were 2–10 times aggressive during a year. Eight patients caused more than 11 incidents a year (ranging from 11–37). We found no significant differences between male and female patients, or between smokers and non-smokers.

Conclusion There is no comparison from the literature on aggression in institutionalized HD patients. Given the high number of incidents, the consequences were limited. We may have a population bias: patients with severe aggression may be admitted to psychiatric hospitals. Attempting to reduce aggression, we started implementing individual observation lists, aimed at identifying triggers and early warning signs. We increased the frequency of multidisciplinary consultation. The impact of aggression incidents was not assessed. We plan to assess the impact of aggression incidents using the Staff Observation Aggression Scale–Revised (SOAS-R).