Concordance between direct observation and staff rating of behavior in nursing home residents with Alzheimer's disease.

This study examined concordance between staff ratings and direct observations of behavior in 177 nursing home residents with Alzheimer's disease. During a structured interview, the staff member who had the most frequent contact with each resident completed three standardized behavioral rating scales. Direct observation of behavior (60 observations per resident) was conducted concurrently by trained nonparticipant observers using a structured time-sampling technique. We found moderate agreement between the two sources for the occurrence of 12 target behaviors during the monitoring period, but generally low agreement regarding the frequency of these behaviors. Discrepancies regarding occurrence of behavior were non-random with a higher rate of detection by direct observation. Thus, the practical advantages of staff ratings of behavior in institutional settings may be partly offset by some reduction in the accuracy of enumeration.