The major goal of this revision is to expand our investigation into the relationships among resident personal characteristics, environmental context, and agitation in the nursing home (NH) using a computer-assisted system of real time behavioral observation. However, in response to preliminary findings from our agitation intervention research, we propose to extend our original aims from the context of an intervention trial. Our original study allowed us to develop a real-time observational system that has been used by the applicant in numerous additional studies and has also been adopted by other research teams. The previous application produced a number of intriguing findings regarding agitation, including precise descriptive data and predictors of occurrence, duration and temporal patterns; sequential conditional probabilities of agitation given staff touch and verbal interaction and exploratory structural equation modeling (SEM) relating agitation, cognitive and functional status, and resident gender over time. The proposal for continuation has 3 specific aims:
Aim 1 : using our system of observation, we will examine the effects of two promising and practical interventions for agitation: environmental white noise and soothing spoken word audiotapes, both delivered to residents via earphones. Intervention groups will be compared to a no treatment control group. An uncomplicated staff management system will be integrated with both intervention protocols to encourage nursing assistants (NAs) compliance with the treatment protocols;
Aim 2; we will examine NA compliance with the protocol and resident response to the interventions over a 12 month period;
Aim 3 : we will continue to examine the relationship among resident personal characteristics, environmental context and agitation both cross-sectionally and longitudinally using SEM. In these analyses, intervention will be considered just one of many variables that can affect agitation over time. We are proposing to expand our investigations by discriminating additional subclassifications of agitation, refining our entry criteria to allow entry of only clinically significant agitated residents, and measuring agitation intensity and resident affect.
