Computer-assisted direct observation of behavioral agitation, engagement, and affect in long-term care residents

The objectives of the current research were (1) to test and evaluate the investigator-designed Behavior, Engagement, and Affect Measure (BEAM) touchpad direct observational data collection tool, and (2) to implement this tool to investigate residents' patterns of behavioral agitation, engagement, affect, behaviors associated with positive mood, general time-activity use, and social interactions within long-term care.

Raters collected cross-sectional observational data and conducted semistructured interviews with participants of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) Study. Researchers tested the BEAM's reliability and validity and evaluated the instrument's discriminate validity for sampling resident behaviors.

Data were collected in 36 long-term care homes. The sample included low-care hostels, high-care nursing homes, and residential facilities offering aging-in-place.

Participants were 406 residents aged 52 to 105 years, with and without dementia.

Researchers collected direct observational data using the BEAM and operationalized behavioral domains based largely on concepts from Kitwood's model of person-centered care. Care staff reported on resident behavior using standardized measures of agitation, depression, quality of life, and social engagement.

The BEAM showed moderate-to-substantial interrater reliability and slight-to-moderate correlations with staff-report data gathered through standardized questionnaire measures. Observations showed that residents spent the greatest amount of time stationary and expressing little emotion, although actively engaged with their environment. Residents were observed to be coping adequately and experiencing a positive social and/or positive care interaction in approximately half of observations; however, close to a third of ratings identified "ill-being." Residents showed more positive behavior, appeared happier and less anxious, and exhibited higher "well-being" during structured activity than during free time or meals.

The BEAM is a reliable and valid observational tool for measuring behavior in long-term care. Long-term care residents expressed little emotion and experienced limited positive social interaction in their daily routine. Increased provision of structured activities may increase resident experiences of positive behavior, affect, and well-being.