The major goal of this proposal is to utilize microcomputer technology for real-time recording of behavioral disturbances and environmental events that may be related to these disturbances. Direct observations will be conducted intensively and consecutively in each of four nursing homes, and will be repeated sequentially among the nursing homes over a two year period of time. Standardized assessments of cognitive and ADL status, as well as evaluations on exploratory measures of medication and health status/life events will also be repeated during each observational epoch over two years. There are three specific aims: (1) based on direct observations, we will report the rate of occurrence and duration of physical aggression, verbal disruption, and pacing/restlessness. Rate and duration will be compared with initial measures of cognitive and ADL status, and the exploratory measures. Analysis will be based on a cross-sectional sample of the first complete observational epoch for 136 residents; (2) based on the same cross-sectional data base, we will examine the relationship between environmental factors and behavioral symptomatology through the use of lag sequential analysis. The influence of cognitive, ADL, medication, and health status on these relationships will also be assessed; (3) we will conduct a longitudinal analysis of the rate and duration of individual resident behavioral symptomatology over a maximum of two years. The focus of this analysis will be on the relationship between change in behavior and changes in cognitive and ADL status, and changes on the exploratory measures. Results of this project will be used to develop environmental/behavioral interventions for the behavioral complications of DAT.
