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Direct observation of behavior: a review of current measures for use with older adults with dementia

Originally Published:
2008
Key Point Summary
Key Point Summary Author(s):
Zborowsky, Terri
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Key Concepts/Context

There are a number of methods to assess specific areas of behavior when evaluating changes in functioning, assessing the effects of an intervention, or measuring the effectiveness of a program of care. Some of these methods include: self-report, caregiver report, and family report of person-specific behaviors. However, self-reporting by dementia patients is often not reasonable given their cognitive decline and communication challenges. Ratings from other people can introduce measurement errors. This article provides information on the theoretical roots, administration methods, and psychometric properties of measures of direct observation of individual behavior.

Objectives

This review looks at methods of direct observation of behaviors for use in long-term care settings, particularly with older adults who have dementia.

Methods

The authors conducted a literature review of direct observation measures of individual behavior for assessing people with dementia. They searched the literature from 1990 through 2007 in the AgeLine, PsycLIT, PubMed, and Sociological Abstracts databases using the keywords dementia and observation, behavior observation, behavior assessment, behavior evaluation, observational measurement, observational assessment, quality of life assessment, affect observation, pain observation, and pain assessment. Finally, the authors gathered relevant references to observational measures cited in the literature obtained from these searches.

Design Implications
Ideally, quality improvement measures should encompass several perspectives using a number of methods to obtain the most valid view of quality of care and quality of life. This would include a combination of direct observation, self-report of individuals with dementia, and reports of their families and formal caregiver.Reviewer note: As industry professionals seek to understand the interaction of people and the designed environment, observation stands out as a gold standard. This article provides an excellent summary of the different types of methods available to conduct high-quality research studies. 
Findings

This study consolidated and evaluated the reviewed literature into the following categories: 

  • Characteristics and Psychometric Properties of Direct Observation Measures of Individual Behavior
  • Characteristics and Psychometric Properties of Direct Observation Measures of Individuals' Affect
  • Characteristics and Psychometric Properties of Direct Observation Measures of Individuals' Activities of Daily Living
  • Characteristics and Psychometric Properties of Direct Observation Measures of Individuals' Quality of Life

In using such methods, the authors concluded that a number of things should be considered, including:

  • how often and when to observe,
  • the behavior or range of behaviors to target, and
  • the psychometric properties desired, depending on the assumptions held about the behavior observed (e.g.,stable trait, sensitive to environmental change).
     
Limitations

Not applicable in this review, however, the authors discuss the limitations of this type of research method.

Setting
Residential healthcare facilities
Key Point Summary Author(s):
Zborowsky, Terri
Primary Author
Curyto, K.J.