Development of an Agitated Behavior Rating Scale for discrete temporal observations

Agitation is a commonly encountered clinical problem, particularly among institutionalized geriatric patients. Agitation is particularly difficult to study because it is manifested in a variety of ways and may occur intermittently across the 24-hour day. Existing ratings scales offer rich behavioral descriptions of agitated behavior but fail to take into account the real-time component of when such behaviors occur. In this article we report the development of an agitated behavior rating scale based on discrete, intermittent real-time observation. Results indicated high levels of interobserver agreement among three trained observers. Percentage agreement exceeded 85% and kappa coefficients were statistically significant at the .001 level for the most general categories of agitation. More specific categories of agitation yielded slightly lower, but still acceptable percentage agreements and kappas. These findings suggest that such a rating scale may have utility in the study of agitation and related phenomena across the 24-hour day.