Individual Resident Characteristics Research Articles

Qilian Mountain National Park Study on Residents' Willingness to Pay Ecological Compensation and its Influencing Factors

The research on residents' willingness to pay ecological compensation in national parks and its influencing factors is an important basis for establishing the ecological compensation mechanism in national parks. Based on the conditional value method and Logistics model, this paper takes Menyuan area of Qilian Mountain National Park as a case study to study the residents' willingness to pay ecological compensation and its influencing factors. The results show that: (1) The total willingness of residents to pay ecological compensation in Menyuan County will reach 2.01×106~3.02×106 yuan in 2020. (2) The individual characteristics of residents' willingness to pay ecological compensation are as follows: monthly income and education level are positively correlated with residents' willingness to pay. Male's willingness to pay is higher than females, and age and willingness to pay are "n" type distribution; The psychological perception factors are: humanistic environment perception, ecological environment perception and recreation function perception in order from the largest to the smallest. Finally, the paper puts forward some suggestions and measures to improve residents' willingness to pay and promote the protection and development of Qilian Mountain National Park.

Glamour or sham? Residents' perceptions of city branding in a superdiverse city: The case of Rotterdam

This study focused on the reconstruction of residents' city imaginaries in a superdiverse context, and on the question how residents relate to official city branding. This is an important question, as there is great gap in the literature on how residents perceive brands. Eight focus groups were conducted in the city of Rotterdam, which is considered a typical superdiverse city. The focus groups have shown the complexity of developing a city brand that fits residents' experiences, as the daily encounters and memories of residents go much deeper than most branding communications, in which ‘superficial’ assets of the city are put to the front. The raw, messy and multi-faced reality of residents is harshly in line with the ‘picture perfect’ brand image. Especially in a superdiverse city, as Rotterdam, where this ‘messy’ reality on the level of the streets is felt as home for many residents. The focus groups have hence captured a strong sense of belonging to the city, whereas the branding of the municipality raises frustration and feelings of exclusion with residents. The overall feeling of disapproval of the city brand goes beyond individual characteristics of residents, such as age, education level and cultural background.

Kesiapsiagaan Warga dalam Menghadapi Bencana Banjir di Desa Kleco Kulon Kabupaten Sragen

Floods were natural disaster that happened during the rainy season. According to data in 2019, flood occurrence in Central Java was 102 times. The flood disasters in the Sidoharjo sub-district had been caused by heavy rainfall and the geographical location traversed by two rivers, namely the Bengawan Solo river and the Mungkung river. The purpose of this study was to describe the characteristics of residents in Kleco Kulon Village and to determine the relationship between individual characteristics of residents based on gender, age, and education level with the preparedness of residents in facing flood disasters in Kleco Kulon Village.. This study used quantitative research method with a cross-sectional approach. The sampling technique used was accidental sampling, with the research sample of 70 respondents. Based on sex, the majority of respondents were females, covering up to 65.7%. Based on age, the majority of respondents were late adults with the age range of 36-45 years, covering up to 72.9%. Based on education level, the majority of respondents were high school graduates, covering up to 47.1%. The level of preparedness of residents in Kleco Kulon Village against flood disasters is in the very high category, which is 48.6%. There was a correlation between individual characteristics based on sex, age, and educational level with the flood preparedness of residents in the Kleco Kulon village, with a p value of 0,000 <0.05.

How Does the Change of Information Source Affect Residents' Risk Attitudes?

Using data from the China Family Panel Studies (CFPS), this paper investigates the effects of Internet use on residents’ risk attitudes. Both Generalized Ordered Logit Model and Logit model are used to identify the effects of Internet use. The results reveal an association between Internet use and increases in both subjective and objective risk preferences that remains even after we adjust for possible endogeneity. The heterogeneity analysis also reveals that these impacts are different among groups with different reasons for Internet use and different personal characteristics. Our study expands the research on the effects of Internet on people’s concepts from the micro perspective and suggests that while promoting the application of information technology we should also pay attention to the individual characteristics of residents so that we can better share the “digital dividend” brought by the popularization of information technology in the whole society.

An optimal incentive policy for residential prosumers in Chinese distributed photovoltaic market: A Stackelberg game approach

An appropriate policy tool adopted by the government can induce small-scale photovoltaic (PV) installations to alleviate current environmental problems. In this paper, a Stackelberg game model is applied to explore the government's optimal incentive policy and residential prosumers' strategic choices in China's distributed PV market. Regional solar radiation intensity (SRI), Levelized cost of electricity (LCOE), and feed-in tariffs (FIT) are regarded as influencing factors that determine whether the PV investment is inducible in a specific region. The results show that government subsidy is gradually no longer required for smaller-capacity PV investment when the individual characteristics of residents are ignored but only economic benefits are considered. The contribution of government subsidy in the PV market has gradually changed from inducing residents to start investing in solar PV equipment to inducing investment in larger-capacity PV equipment. An appropriate government subsidy can reduce the restrictions of SRI, LCOE, FIT, and other factors on the residential installation. Meanwhile, the results demonstrate the optimal subsidy established according to specific regions can accurately induce residents and maximize the profits of government and residents, while the effectiveness of a unified subsidy policy is very limited. These conclusions can provide valuable insights for policymakers to develop effective and targeted policies.

Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents

Nursing home residents account for approximately 40% of deaths from SARS-CoV-2. To identify risk factors for SARS-CoV-2 incidence, hospitalization, and mortality among nursing home residents in the US. This retrospective longitudinal cohort study was conducted in long-stay residents aged 65 years or older with fee-for-service Medicare residing in 15 038 US nursing homes from April 1, 2020, to September 30, 2020. Data were analyzed from November 22, 2020, to February 10, 2021. The main outcome was risk of diagnosis with SARS-CoV-2 (per International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) by September 30 and hospitalization or death within 30 days after diagnosis. Three-level (resident, facility, and county) logistic regression models and competing risk models conditioned on nursing home facility were used to determine association of patient characteristics with outcomes. Among 482 323 long-stay residents included, the mean (SD) age was 82.7 (9.2) years, with 326 861 (67.8%) women, and 383 838 residents (79.6%) identifying as White. Among 137 119 residents (28.4%) diagnosed with SARS-CoV-2 during follow up, 29 204 residents (21.3%) were hospitalized, and 26 384 residents (19.2%) died within 30 days. Nursing homes explained 37.2% of the variation in risk of infection, while county explained 23.4%. Risk of infection increased with increasing body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) (eg, BMI>45 vs BMI 18.5-25: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.15-1.24) but varied little by other resident characteristics. Risk of hospitalization after SARS-CoV-2 increased with increasing BMI (eg, BMI>45 vs BMI 18.5-25: aHR, 1.40; 95% CI, 1.28-1.52); male sex (aHR, 1.32; 95% CI, 1.29-1.35); Black (aHR, 1.28; 95% CI, 1.24-1.32), Hispanic (aHR, 1.20; 95% CI, 1.15-1.26), or Asian (aHR, 1.46; 95% CI, 1.36-1.57) race/ethnicity; impaired functional status (eg, severely impaired vs not impaired: aHR, 1.15; 95% CI, 1.10-1.22); and increasing comorbidities, such as renal disease (aHR, 1.21; 95% CI, 1.18-1.24) and diabetes (aHR, 1.16; 95% CI, 1.13-1.18). Risk of mortality increased with age (eg, age >90 years vs 65-70 years: aHR, 2.55; 95% CI, 2.44-2.67), impaired cognition (eg, severely impaired vs not impaired: aHR, 1.79; 95% CI, 1.71-1.86), and functional impairment (eg, severely impaired vs not impaired: aHR, 1.94; 1.83-2.05). These findings suggest that among long-stay nursing home residents, risk of SARS-CoV-2 infection was associated with county and facility of residence, while risk of hospitalization and death after SARS-CoV-2 infection was associated with facility and individual resident characteristics. For many resident characteristics, there were substantial differences in risk of hospitalization vs mortality. This may represent resident preferences, triaging decisions, or inadequate recognition of risk of death.

The Association of Nursing Home Characteristics and Quality with Adverse Events After a Hospitalization

Background/ObjectivesWe previously found high rates of adverse events (AEs) for long-stay nursing home residents who return to the facility after a hospitalization. Further evidence about the association of AEs with aspects of the facilities and their quality may support quality improvement efforts directed at reducing risk. DesignProspective cohort analysis. Setting and Participants32 nursing homes in the New England states. A total of 555 long-stay residents contributed 762 returns from hospitalizations. MethodsWe measured the association between AEs developing in the 45 days following discharge back to long-term care and characteristics of the nursing homes including bed size, ownership, 5-star quality ratings, registered nurse and nursing assistant hours, and the individual Centers for Medicare & Medicaid Services (CMS) quality indicators. We constructed Cox proportional hazards models controlling for individual resident characteristics that were previously found associated with AEs. ResultsWe found no association of AEs with most nursing home characteristics, including 5-star quality ratings and the composite quality score. Associations with individual quality indicators were inconsistent and frequently not monotonic. Several individual quality indicators were associated with AEs; the highest tertile of percentage of residents with depression (4%-25%) had a hazard ratio (HR) of 1.65 [95% confidence interval (CI) 1.16, 2.35] and the highest tertile of the percentage taking antipsychotic medications (18%-35%) had an HR of 1.58 (CI 1.13, 2.21). The percentage of residents needing increased assistance with activities of daily living was statistically significant but not monotonic; the middle tertile (13% to <20%) had an HR of 1.69 (CI 1.16, 2.47). Conclusions and ImplicationsAEs occurring during transitions between nursing homes and hospitals are not explained by the characteristics of the facilities or summary quality scores. Development of risk reduction approaches requires assessment of processes and quality beyond the current quality measures.

The Influence Path of Community Environment and Residents' Health in Case of Fuzhou, China

Urban health has become an important issue of concern in the world. However, the influence path of community environment on residents' health is not significant. In this study, 1,308 samples were collected from Fuzhou City in China. At the micro level of the community, the research explored the influence path of the community environment on the residents' health based on the intermediary effect of physical activity by building structural equation method. It was found that the built environment and social environment affected physical health through the intermediary effect of physical activity. The social environment directly affected mental health, and the built environment affected mental health through the intermediary role of social environment. Physical health and mental health affected each other. The individual characteristics of residents also affected their health. There were great differences in the influence path of community environment on male's health and female's health.

Gastroenteritis and respiratory infection outbreaks in French nursing homes from 2007 to 2018: Morbidity and all-cause lethality according to the individual characteristics of residents.

BackgroundGastroenteritis (GE) and respiratory tract infection (RTI) outbreaks are a significant issue in nursing homes. This study aimed to describe GE and RTI outbreaks with infection and all-cause lethality rates according to the individual characteristics of nursing home residents.MethodsClinical and virological surveillance were conducted (2007 to 2018). Virus stratifications for the analysis were: outbreaks with positive norovirus or influenza identifications (respectively NoV+ or Flu+), episodes with no NoV or influenza identification or testing (respectively NoV- or Flu-). Associations between individual variables (sex, age, length of stay (LOS), autonomy status) and infection and lethality rates were tested with univariate and Mantel-Haenszel (MH) methods.Results61 GE outbreaks and 76 RTI oubreaks (total 137 outbreaks) were recorded involving respectively 4309 and 5862 residents. In univariate analysis, higher infection rates and age were associated in NoV+, NoV-, and Flu+ contexts, and lower infection rates were associated with longer stays (NoV+ and NoV-). In MH stratified analysis (virus, sex (female/male)) adjusted for LOS (<4 or ≥4 years), the odds of being infected remained significant among older residents (≥86 years): NoV+/male (Odds ratio (ORMH): 1.64, 95% confidence interval (CI): 1.16–2.30) and Flu+/female and male (respectively ORMH: 1.50, CI: 1.27–1.79 and 1.73, CI: 1.28–2.33). In univariate analysis, lower autonomy status (NoV+, Flu+ and Flu-) and increased age (Flu+) were associated with higher lethality. In MH adjusted analysis, significant ORage adjusted for autonomy was: Flu+/ ≥86 years compared with <86 years, 1.97 (1.19–3.25) and ORautonomy adjusted for age for the more autonomous group (compared with the less autonomous group) was: Flu+, 0.41 (0.24–0.69); Flu-, 0.42 (0.20, 0.90).ConclusionThe residents of nursing homes are increasingly elderly and dependent. The specific infection and lethality risks according to these two factors indicate that surveillance and infection control measures are essential and of high priority.

Place attachment and determinants of living arrangement in the family house in Ibadan, Nigeria

Context/Background: There is a dearth of study in identifying the determinants of choice of living arrangement in sub-Saharan Africa and what influences individual’s decision about this. Therefore, this study examined the physical aspects and demographic characteristics that may be significant predictors of attachment to a particularly form of living arrangement in the form of “family house” otherwise called agbo’le . Data source and Methods: The analysis was based on quantitative data from 413 household heads in a traditional neighborhood characterized mainly by agbo’les in Ibadan, Nigeria. Descriptive statistics, chi-square, regression analysis and correlation were used to analyse the data. Results: The results showed that demographic factors including education attained, occupation and nature of work were significant predictors of place attachment rather than the physical structure. Conclusion: The study concluded that the relevance of agbo’le to the lives of the residents and hence its future potentials are more influenced by characteristics of individual residents.

Who is watching: exploring individual factors that explain supervision patterns among residential guardians

Supervision has been identified within criminology as an important element of crime prevention; however, little is known about the individual factors that explain this behaviour among residential guardians. Unique self-report data on daily surveillance routines of residents were gathered from a national sample of 4824 respondents in the Netherlands to explore the key factors that facilitate and inhibit supervision. It was tentatively estimated that residents carry out supervision roughly a quarter of the time they are at home. Further analyses revealed that individual resident characteristics, such as their perceptions of crime, sense of responsibility for guarding, security training, courageousness and national security values positively predict supervision intensity. Conversely, self-esteem and trust were found to negatively affect supervision. Results suggest that manipulable individual factors such as attitudes are more important at predicting supervision than comparatively static factors such as personality. Implications for criminological theory that explains the concept of supervision as a function of guardianship, and how it can be fostered as a crime control mechanism within residential contexts, will be discussed.

Ongelijkheid in de participatiestad

Abstract The current retrenchment of European welfare states is putting more emphasis on citizen participation as an alternative for public services. This study examines differences in neighbourhood participation between urban neighbourhoods in Rotterdam in which, given their population composition, active citizen’s participation is expected to differ. We also examine to which extent neighbourhood characteristics such as neighbourhood deprivation, ethnic diversity and organizational infrastructure and individual characteristics of residents explain variations in neighbourhood participation between neighbourhoods. Using a large survey dataset, bivariate analyses show strong associations between neighbourhood characteristics and average levels of citizen participation. Multilevel regression analysis reveals that these differences in citizen participation are predominantly explained by individual characteristics such as education and age. Our findings show that the current focus on civic participation may result in more inequality: citizens in advantageous positions are at least better equipped to adapt to the retrenchment of the welfare state than those in disadvantaged positions.

FUZZY LOGIC CONTROLLER FOR SMART HOME LIGHTING CONTROL

Background. Modern high-tech automation systems are able to provide unmanned productive and efficient management of smart home functions. These systems should provide control of temperature, light level, humidity and air pollution for a comfortable stay in the building. In particular, fuzzy logic controller has the potential for application in intelligent systems of lighting control. Objective. The aim of the paper is to design the two-channel lighting control system in smart home that provides control of lighting source power and of their spectral characteristics. Methods. The lighting control system is based on fuzzy inference and provides forming the base of fuzzy production rules, fuzzification of input values, aggregation of truth of sub conditions of each rule, activation of conclusions and defuzzification process that generates an output signal to control the smart home functional devices. Results. The crisp values of light source power with different spectral characteristics and output signal that controls the transparency of windows have been obtained in result of representation of input data of different types using linguistic variables and fuzzy production rules for the current values of natural light and time of day. It is shown the possibility to change the sensitivity of the control systems in different ranges of illumination deviation from optimal values. Conclusions. The lighting control method in buildings based on fuzzy logic controller enables to get the quantitative values of power of light sources with different spectral characteristics taking into account the individual characteristics of residents. Keywords: lighting control; fuzzy logic controller; production rules; fuzzy sets; conclusions activation.

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities.

Understanding the extent to which current antibiotic prescribing behaviour is influenced by clinicians' historical patterns of practice will help target interventions to optimize antibiotic use in long-term care. Our objective was to evaluate whether clinicians' historical prescribing behaviours influence the start, prolongation and class selection for treatment with antibiotics in residents of long-term care facilities. We conducted a retrospective cohort study of all physicians who prescribed to residents in long-term care facilities in Ontario between Jan. 1 and Dec. 31, 2014. We examined variability in antibiotic prescribing among physicians for 3 measures: start of treatment with antibiotics, use of prolonged durations exceeding 7 days and selection of fluoroquinolones. Funnel plots with control limits were used to determine the extent of variation and characterize physicians as extreme low, low, average, high and extreme high prescribers for each tendency. Multivariable logistic regression was used to assess whether a clinician's prescribing tendency in the previous year predicted current prescribing patterns, after accounting for residents' demographics, comorbidity, functional status and indwelling devices. Among 1695 long-term care physicians, who prescribed for 93 132 residents, there was wide variability in the start of antibiotic treatment (median 45% of patients, interquartile range [IQR] 32%-55%), use of prolonged treatment durations (median 30% of antibiotic prescriptions, IQR 19%-46%) and selection of fluoroquinolones (median 27% of antibiotic prescriptions, IQR 18%-37%). Prescribing tendencies for antibiotics by physicians in 2014 correlated strongly with tendencies in the previous year. After controlling for individual resident characteristics, prior prescribing tendency was a significant predictor of current practice. Physicians prescribing antibiotics exhibited individual, measurable and historical tendencies toward start of antibiotic treatment, use of prolonged treatment duration and class selection. Prescriber audit and feedback may be a promising tool to optimize antibiotic use in long-term care facilities.

Risk factors for methicillin-resistant Staphylococcus aureus carriage among residents in 7 nursing homes in Shanghai, China

Nursing home residents are a population at risk for methicillin-resistant Staphylococcus aureus (MRSA) carriage, but few data about MRSA in this setting in Shanghai are available. The aim of this study is to determine the prevalence and risk factors for MRSA carriage in nursing home residents in Shanghai, China. Four hundred forty-three residents from 7 nursing homes in Shanghai, China, participated in this study; nasal and axillary swabs were obtained from these residents. Laboratory identification for S aureus and antimicrobial susceptibility testing were performed when isolated. Data, including individual resident characteristics and nursing home characteristics, were collected and analyzed. Of the 443 participating residents, 99 (22.3%) and 45 (10.2%) residents were colonized by S aureus and MRSA, respectively. Previous hospitalization (odds ratio [OR], 2.564; 95% confidence interval [CI], 1.214-5.415; P = .014), presence of an invasive device (OR, 3.455; 95% CI, 1.678-7.113; P = .001), chloramphenicol therapy (OR, 7.672; 95% CI, 1.807-32.580; P = .006), and macrolides therapy (OR, 2.796; 95% CI, 1.056-7.403; P = .038) were independent risk factors for MRSA colonization. Low expenditure per month and less good sanitary condition also increased the risk for MRSA colonization. Our study suggests that nursing homes are significant reservoirs for MRSA. Implementation of infection control strategies must be given high priority in nursing homes to fight the high prevalence of MRSA, and increased convenience and feasibility should also be realized with these control strategies for MRSA colonization.

Assessment of cognitive biases and biostatistics knowledge of medical residents: a multicenter, cross-sectional questionnaire study

PurposeThe aim of this study is to determine the perceived familiarity of medical residents with statistical concepts, assess their ability to integrate these concepts in clinical scenarios, and investigate their susceptibility to the gambler's fallacy and the conjunction fallacy.MethodsA multi-institutional, cross-sectional survey of Greek medical residents was performed. Participants were asked to indicate their familiarity with basic statistical concepts and answer clinically oriented questions designed to assess their biostatistics knowledge and cognitive biases. Univariate, bivariate, and multivariate statistical models were used for the evaluation of data.ResultsOut of 153 respondents (76.5% response rate), only two participants (1.3%) were able to answer all seven biostatistics knowledge questions correctly while 29 residents (19%) gave incorrect answers to all questions. The proportion of correct answers to each biostatistics knowledge question ranged from 15 to 51.6%. Residents with greater self-reported familiarity were more likely to perform better on the respective knowledge question (all p<0.01). Multivariate analysis of the effect of individual resident characteristics on questionnaire performance showed that previous education outside Greece, primarily during medical school, was associated with lower biostatistics knowledge scores (p<0.001). A little more than half of the respondents (54.2%) answered the gambler's fallacy quiz correctly. Residents with higher performance on the biostatistics knowledge questions were less prone to the gambler's fallacy (odds ratio 1.38, 95% confidence intervals 1.12–1.70, p=0.003). Only 48 residents (31.4%) did not violate the conjunction rule.ConclusionsA large number of medical residents are unable to correctly interpret crucial statistical concepts that are commonly found in the medical literature. They are also especially prone to the gambler's fallacy bias, which may undermine clinical judgment and medical decision making. Formalized systematic teaching of biostatistics during residency will be required to de-bias residents and ensure that they are proficient in understanding and communicating statistical information.

Inequalities in avoidable hospitalisation by area income and the role of individual characteristics: a population-based register study in Stockholm County, Sweden

BackgroundAvoidable hospitalisations are hospital admissions for medical conditions that could potentially have been prevented by outpatient healthcare. They are used as an indicator of access to and quality of primary...

Prevalence of incontinence by race and ethnicity of older people admitted to nursing homes.

While admissions of minorities to nursing homes (NHs) are increasing and prevalence of incontinence in NHs remains high, little is known about incontinence among racial-ethnic groups of NH admissions other than blacks. The purpose of this study was to describe the prevalence of incontinence among older adults admitted to NHs by race/ethnicity at three levels of measurement: individual resident, NH, and Census division. Cross-sectional and descriptive. Admissions of persons age 65 or older to 1 of 457 NHs of a national, for-profit chain over 3 years 2000-2002 (n = 111,640 residents). Data sources were the Minimum Data Set v. 2.0 and 2000 US Census. Prevalence of the following definitions of incontinence was analyzed: Only Urinary Incontinence (UI), Only Fecal Incontinence (FI), Dual Incontinence (DI; UI and FI), Any UI (UI with or without FI), Any FI (FI with or without UI), and Any Incontinence (UI and/or FI and/or DI). Asian patients, black patients, and Hispanic patients had a higher prevalence of Any Incontinence (67%, 66%, and 58%, respectively) compared to white patients (48%) and American Indian patients (46%). At the NH level, all prevalence measures of incontinence (except Only UI) appear to trend in the opposite direction from the percentage of NH admissions who were white. Among Asian and white patients, there was a higher prevalence of all types of incontinence in men compared with women except for Only UI. Among Census divisions, the prevalence of all types of incontinence, except Only UI, was lowest in the 2 divisions with the highest percentage of white admissions to their NHs. NHs admitting more racial/ethnic minorities may be faced with managing more incontinence and needing additional staffing resources. The association of the prevalence of most types of incontinence with the race/ethnicity of NH admissions at all levels of measurement lend support to the growing evidence that contextual factors beyond individual resident characteristics may contribute to NH differences.

Person–environment interactions among residents of Oxford Houses

The continued struggle of addiction recovery support systems suggest that the paradigm of this field needs to continue its evolution, which has increasingly emphasized environments. Field Theory suggests that the products of individual and environmental characteristics be considered rather than a summation of the two. This study examined such interactions in Oxford Houses, a network of democratic, and self-governed addiction recovery homes. This study examined sobriety in experienced houses (average length of residency > six months) compared to less experienced houses (average length of residency ≤ six months) in relation to individual resident characteristics (age, length of residence in an Oxford House, and referral from the criminal justice system). Using multilevel modeling, findings indicated that older residents living in an experienced Oxford Houses were more likely to remain abstinent over time than those in inexperienced homes. Additionally, for inexperienced houses, residents who had been in the Oxford House for a longer period had a higher the probability of abstinence than those that had been in the house for a shorter period of time. Finally, legal referral was related to a lower probability of one-year abstinence but only for those in experienced homes. These types of person–environment interactions point to the need for more research to better understand how person variables interact with environmental variables in the processes of recovery and adaptation to settings, as well as for treatment professionals’ consideration of both person and environment when making recovery home referrals.

A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. The study included participants (N = 78) from a larger study who completed either 12 or 18 months of data collection. There were four measurement points, each separated by 6-month intervals. We recorded agitation using two measures: (a) the computer-assisted behavioral observation system (CABOS) and (b) the staff-completed Nursing Home Behavior Problem Scale. We used longitudinal hierarchical linear modeling to capture the dynamic nature of behavior change as a function of individual resident characteristics and time. The profoundly cognitively impaired residents (M Mini-Mental State Examination [MMSE] score = 1.7) displayed more agitation than the moderately impaired group (M MMSE score = 15.4) at Epoch 1 (cross-sectional analyses). Longitudinal analysis found a significant linear and quadratic trend only with the profoundly impaired residents using the CABOS. These residents showed slight improvements in agitation up to 12 months, with agitation increasing significantly from 12 to 18 months. With nursing homes receiving an increasing number of profoundly cognitively impaired residents, these results have potential cost and policy implications. Measuring agitation over time by using both staff report and observation measures presents various problems, and we present an alternative measure that may help to avoid these difficulties.