Sarinnapha M Vasunilashorn1,2,3, Dena Schulman-Green4, Douglas Tommet5, Tamara G Fong6,7,8, Tammy T Hshieh6,9, Edward R Marcantonio6,10,7, Eran D Metzger6,11, Eva M Schmitt7, Patricia A Tabloski12, Thomas G Travison6,7, Yun Gou7, Benjamin Helfand13, Sharon K Inouye6,10,7, Richard N Jones5,14. 1. Harvard Medical School, Boston, Massachusetts, USA, svasunil@bidmc.harvard.edu. 2. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, svasunil@bidmc.harvard.edu. 3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA, svasunil@bidmc.harvard.edu. 4. Yale University School of Nursing, New Haven, Connecticut, USA. 5. Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA. 6. Harvard Medical School, Boston, Massachusetts, USA. 7. Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA. 8. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 9. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 10. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 11. Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 12. William F. Connell School of Nursing at Boston College, Boston, Massachusetts, USA. 13. University of Massachusetts Medical School, Worcester, Massachusetts, USA. 14. Department of Psychiatry and Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
Abstract
BACKGROUND: Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies. OBJECTIVE: We aimed to report our development of new delirium severity items and the results of item reduction and selection activities guided by psychometric analysis of data derived from a field study. METHODS: Building on our literature review of delirium instruments and expert panel process to identify domains of delirium severity, we adapted items from existing delirium severity instruments and generated new items. We then fielded these items among a sample of 352 older hospitalized patients. RESULTS: We used an expert panel process and psychometric data analysis techniques to narrow a set of 303 potential items to 17 items for use in a new delirium severity instrument. The 17-item set demonstrated good internal validity and favorable psychometric characteristics relative to comparator instruments, including the Confusion Assessment Method - Severity (CAM-S) score, the Delirium Rating Scale Revised 98, and the Memorial Delirium Assessment Scale. CONCLUSION: We more fully conceptualized delirium severity and identified characteristics of an ideal delirium severity instrument. These characteristics include an instrument that is relatively quick to administer, is easy to use by raters with minimal training, and provides a severity rating with good content validity, high internal consistency reliability, and broad domain coverage across delirium symptoms. We anticipate these characteristics to be represented in the subsequent development of our final delirium severity instrument.
BACKGROUND:Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies. OBJECTIVE: We aimed to report our development of new delirium severity items and the results of item reduction and selection activities guided by psychometric analysis of data derived from a field study. METHODS: Building on our literature review of delirium instruments and expert panel process to identify domains of delirium severity, we adapted items from existing delirium severity instruments and generated new items. We then fielded these items among a sample of 352 older hospitalized patients. RESULTS: We used an expert panel process and psychometric data analysis techniques to narrow a set of 303 potential items to 17 items for use in a new delirium severity instrument. The 17-item set demonstrated good internal validity and favorable psychometric characteristics relative to comparator instruments, including the Confusion Assessment Method - Severity (CAM-S) score, the Delirium Rating Scale Revised 98, and the Memorial Delirium Assessment Scale. CONCLUSION: We more fully conceptualized delirium severity and identified characteristics of an ideal delirium severity instrument. These characteristics include an instrument that is relatively quick to administer, is easy to use by raters with minimal training, and provides a severity rating with good content validity, high internal consistency reliability, and broad domain coverage across delirium symptoms. We anticipate these characteristics to be represented in the subsequent development of our final delirium severity instrument.
Authors: Eva M Schmitt; Jacqueline Gallagher; Asha Albuquerque; Patricia Tabloski; Hyo Jung Lee; Lauren Gleason; Lauren S Weiner; Edward R Marcantonio; Richard N Jones; Sharon K Inouye; Dena Schulman-Green Journal: Gerontologist Date: 2019-03-14
Authors: Alessandro Morandi; Christian Pozzi; Koen Milisen; Hans Hobbelen; Jennifer M Bottomley; Alessandro Lanzoni; Verena C Tatzer; Maria Gracia Carpena; Antonio Cherubini; Anette Ranhoff; Alasdair M J MacLullich; Andrew Teodorczuk; Giuseppe Bellelli Journal: BMC Geriatr Date: 2019-09-11 Impact factor: 3.921
Authors: Benjamin K I Helfand; Douglas Tommet; Elke Detroyer; Koen Milisen; Dimitrios Adamis; Eran D Metzger; Edward R Marcantonio; Edwin D Boudreaux; Sharon K Inouye; Richard N Jones Journal: Dement Geriatr Cogn Disord Date: 2022-05-09 Impact factor: 3.346
Authors: Dena Schulman-Green; Tammy Hshieh; Dimitrios Adamis; Michael S Avidan; Dan G Blazer; Donna M Fick; Esther Oh; Alessandro Morandi; Catherine Price; Joe Verghese; Eva M Schmitt; Richard N Jones; Sharon K Inouye Journal: J Am Geriatr Soc Date: 2021-12-24 Impact factor: 5.562
Authors: Sarinnapha M Vasunilashorn; Tamara G Fong; Benjamin K I Helfand; Tammy T Hshieh; Edward R Marcantonio; Eran D Metzger; Eva M Schmitt; Patricia A Tabloski; Thomas G Travison; Yun Gou; Richard N Jones; Sharon K Inouye Journal: JAMA Netw Open Date: 2022-03-01