Dena Schulman-Green1, Tammy Hshieh2,3, Dimitrios Adamis4,5, Michael S Avidan6, Dan G Blazer7, Donna M Fick8, Esther Oh9, Alessandro Morandi10,11, Catherine Price12, Joe Verghese13, Eva M Schmitt3, Richard N Jones14, Sharon K Inouye3,15,16. 1. New York University Rory Meyers College of Nursing, New York, New York, USA. 2. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 3. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA. 4. Sligo Mental Health Services, Sligo, Ireland. 5. Research and Academic Institute of Athens, Athens, Greece. 6. Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA. 7. Duke University School of Medicine, Durham, North Carolina, USA. 8. Penn State Ross and Carol Nese College of Nursing, University Park, Pennsylvania, USA. 9. The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 10. Fondazione Teresa Camplani, Cremona, Italy. 11. Parc Sanitari Pere Virgili and Vall d'Hebrón Institute of Research, Barcelona, Spain. 12. University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA. 13. Albert Einstein School of Medicine, Bronx, New York, USA. 14. Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. 15. Harvard Medical School, Boston, Massachusetts, USA. 16. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
BACKGROUND: The ability to rate delirium severity is key to providing optimal care for persons with Alzheimer's Disease and Related Dementias (ADRD). Such ratings would allow clinicians to assess response to treatment, recovery time and prognosis, nursing burden and staffing needs, and to provide nuanced, appropriate patient-centered care. Given the lack of existing tools, we defined content domains for a new delirium severity instrument for use in individuals with mild to moderate ADRD, the DEL-S-AD. METHODS: We built upon our previous study in which we created a content domain framework to inform development of a general delirium severity instrument, the DEL-S. We engaged a new expert panel to discuss issues of measurement in delirium and dementia and to determine which content domains from the prior framework were useful in characterizing delirium severity in ADRD. We also asked panelists to identify new domains. Our panel included eight interdisciplinary members with expertise in delirium and dementia. Panelists participated in two rounds of review followed by two surveys over 2 months. RESULTS: Panelists endorsed the same content domains as for general delirium severity, including Cognitive, Level of Consciousness, Inattention, Psychiatric-Behavioral, Emotional Dysregulation, Psychomotor Features, and Functional; however, they excluded six of the original subdomains which they considered unhelpful in the context of ADRD: cognitive impairment; anxiety; fear/sense of unease; depression; gait/walking; and incontinence. Debated measurement challenges included assessment at one point in time versus over time, accounting for differences in clinical settings, and accurate assessment of symptoms related to delirium versus dementia. CONCLUSIONS: By capturing a range of characteristics of delirium severity potentially present in patients with ADRD, a population that may already have attention, functional, and emotional changes at baseline, the DEL-S-AD provides a novel rating tool that will be useful for clinical and research purposes to improve patient care.
BACKGROUND: The ability to rate delirium severity is key to providing optimal care for persons with Alzheimer's Disease and Related Dementias (ADRD). Such ratings would allow clinicians to assess response to treatment, recovery time and prognosis, nursing burden and staffing needs, and to provide nuanced, appropriate patient-centered care. Given the lack of existing tools, we defined content domains for a new delirium severity instrument for use in individuals with mild to moderate ADRD, the DEL-S-AD. METHODS: We built upon our previous study in which we created a content domain framework to inform development of a general delirium severity instrument, the DEL-S. We engaged a new expert panel to discuss issues of measurement in delirium and dementia and to determine which content domains from the prior framework were useful in characterizing delirium severity in ADRD. We also asked panelists to identify new domains. Our panel included eight interdisciplinary members with expertise in delirium and dementia. Panelists participated in two rounds of review followed by two surveys over 2 months. RESULTS: Panelists endorsed the same content domains as for general delirium severity, including Cognitive, Level of Consciousness, Inattention, Psychiatric-Behavioral, Emotional Dysregulation, Psychomotor Features, and Functional; however, they excluded six of the original subdomains which they considered unhelpful in the context of ADRD: cognitive impairment; anxiety; fear/sense of unease; depression; gait/walking; and incontinence. Debated measurement challenges included assessment at one point in time versus over time, accounting for differences in clinical settings, and accurate assessment of symptoms related to delirium versus dementia. CONCLUSIONS: By capturing a range of characteristics of delirium severity potentially present in patients with ADRD, a population that may already have attention, functional, and emotional changes at baseline, the DEL-S-AD provides a novel rating tool that will be useful for clinical and research purposes to improve patient care.
Authors: Tamara G Fong; Daniel Davis; Matthew E Growdon; Asha Albuquerque; Sharon K Inouye Journal: Lancet Neurol Date: 2015-06-29 Impact factor: 44.182
Authors: Tamara G Fong; Richard N Jones; Edward R Marcantonio; Douglas Tommet; Alden L Gross; Daniel Habtemariam; Eva Schmitt; Liang Yap; Sharon K Inouye Journal: Ann Intern Med Date: 2012-06-19 Impact factor: 25.391
Authors: Alden L Gross; Richard N Jones; Daniel A Habtemariam; Tamara G Fong; Douglas Tommet; Lien Quach; Eva Schmitt; Liang Yap; Sharon K Inouye Journal: Arch Intern Med Date: 2012-09-24