This application requests a Mentored Patient-Oriented Research Career Development Award (K23). The candidate is a geriatric psychiatrist and Assistant Professor of Psychiatry at the University of Pittsburgh who proposes to develop research skills for geriatric psychiatry research in long-term care settings. Funding of this award would provide the protected time and resources necessary for him to develop into an independent investigator capable of conducting observational and intervention studies of agitation and aggression in nursing home residents with dementia. Agitation is the foremost behavioral management problem in nursing homes. More specifically, it is aggressive behaviors (verbal, physical or sexual) that pose the greatest safety risk to other residents and staff. To date, however, aggression has not been studied as a distinct construct due to the methodological challenges of capturing and analyzing low frequency (but high impact) behaviors. In the absence of a sound understanding of the prevalence, clinical and environmental correlates of aggression, evidence-based prevention and intervention strategies have not been possible. The candidate proposes to tackle the methodological challenges of capturing low frequency aggressive behaviors by employing novel video and audio processing technologies that will permit real-time continuous digital recordings of behaviors in their natural context, and efficient data extraction to eliminate large volumes of redundant and irrelevant data. To perform such research, the candidate will develop nursing homes as clinical research sites, acquire skills in behavioral assessment and measurement methodologies, and the ethical conduct of research involving digitally captured data. The proposed research will involve an observational, longitudinal study on a 55-bed dementia unit that will be instrumented to capture the activities and behaviors of nursing home residents in non-private areas for 12 hours/day for 4 weeks The results of the digitally captured and processed data will be compared with behavioral rating instruments completed by the usual nursing home staff and a research associate.
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