SUMMARYThis article describes the development of a direct observation system for the assessment of the behaviour of elderly demented long-stay patients. The technique of recording behaviour in real time has high face validity, and in conjunction with portable computers was found to be very reliable. The technique was used to assess the behaviour of patients during their waking day on seven wards. The findings suggest that almost two-thirds of the day is spent doing nothing, with aimless or disruptive behaviours also accounting for a significant period of the day. Only a small proportion of the day was spent in self-care or social behaviours.KEY woms-Dementia, long-stay wards, observation, behaviour.As part of a larger project to investigate the effects of ward environment on the behaviour of long-stay elderly confused patients, a method of behavioural assessment, via observation, was developed. The first part of this article will describe the development of an instrument which accurately measures the behaviour of demented patients. The second part reports the results of its application and gives an insight into what actually happens during aday in the life of these patients. The findings are compared with those of Godlove et al. (1982), whose observations suggested that the recipients of long-term care spent two-thirds of their time doing nothing. Despite the reactions to this finding at the time, the relative lack of activity in institutional care still appears to be high, and the question of 'What happens during the average day in the life of a long-stay demented patient?' is examined and quantified.
DEVELOPMENT OF THE OBSERVATION INSTRUMENT
Review of methods of collecting behavioural dataOne method of obtaining data about patient behaviour is via the application of rating scales. BehavCorrespondence to first author.iour rating scales, such as the Behaviour Rating Scale of the Clifton Assessment Procedures for the Elderly (Pattie and Gilleard, 1975), produce data that reflect patient dependency rather than a quantification of behaviour. A number of rating scales to assess aggressive behaviour in psychiatric patients have been developed, and more recently one specifically designed to assess aggressive behaviour in the elderly (Pate1 and Hope, 1992). Aggressive behaviour rating scales are by definition focusing on one small aspect of behaviour; other scales have been developed to assess a broader range of disruptive behaviours occurring in demented patients (Greene et al., 1982;Swearer et al., 1988; Mungas et al., 1989). These scales, however, tend to lack a comprehensive range of items and do not allow for comparisons with other non-disruptive behaviours which are not assessed.An alternative method of recording behaviour is by direct observation. Advocates of this method of research (Sanson-Fisher et al., 1979;Whatmore et al., 1975) argue that it is a richer and more accurate method of collecting information.Observational methods have been used for recording patientklient behaviour in a variety of settings for m...