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  • 1
    Online Resource
    Online Resource
    The Better Assessment of Illness Study for Delirium Severity: Study Design, Procedures, and Cohort Description
    S. Karger AG ; 2019
    In:  Gerontology Vol. 65, No. 1 ( 2019), p. 20-29
    Details
    In: Gerontology, S. Karger AG, Vol. 65, No. 1 ( 2019), p. 20-29
    Abstract: 〈 b 〉 〈 i 〉 Background/Objectives: 〈 /i 〉 〈 /b 〉 To describe the design, procedures, and cohort for the Better ASsessment of ILlness ­(BASIL) study, which is conducted to develop and test new delirium severity measures, compare them with existing measures, and examine related clinical outcomes. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Prospective cohort study with 1 year follow-up of study participants at a large teaching hospital in Boston, Massachusetts. After brief cognitive testing and the Delirium Symptom Interview, delirium and delirium severity were rated daily in the hospital using the Confusion Assessment Method (CAM) and CAM-Severity score, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Memorial Delirium Assessment Scale (MDAS). Other key study variables included comorbidity, physical function (basic and instrumental activities of daily living [ADL] ), ratings of subjective health and well-being, and clinical outcomes (length of stay, 30 day rehospitalization, nursing home admission, healthcare utilization). Follow-up interviews occurred at 1- and 12-month with patients and families. In 42 patient interviews, inter-rater reliability for key variables was assessed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 768 eligible patients approached, 469 were screened and 352 enrolled, yielding an overall study response rate of 67% for potentially eligible participants. The mean participant was 80.3 years old (SD 6.8) and 203 (58%) were female. The majority of patients were medically complex with Charlson Comorbidity Scores ≥2 (192 patients, 55%), and 102 (29%) met criteria for dementia. Inter-rater reliability assessments ( 〈 i 〉 n 〈 /i 〉 = 42 pairs) were high for overall ratings of presence or absence of delirium by CAM ( 〈 i 〉 κ 〈 /i 〉 = 1.0), delirium severity by DRS-R-98 and MDAS (weighted kappa, 〈 i 〉 κ 〈 /i 〉 = 1.0 for each) and for ADL impairment ( 〈 i 〉 κ 〈 /i 〉 = 1.0). For eligible participants at each time point, 278 out of 308 (90%) completed the 1-month follow-up and 132 out of 256 (53%) have completed the 12-month follow-up to date, which is still in progress. Among those who completed interviews, there was only 1–3% missing data on most major outcomes (delirium, basic ADL, and readmission). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The BASIL study presents an innovative effort to advance the conceptualization and measurement of delirium severity. Unique strengths include the diverse cohort with complete high quality data and longitudinal follow-up, along with detailed collection of multiple delirium measures daily during hospitalization.
    Type of Medium: Online Resource
    ISSN: 0304-324X , 1423-0003
    URL: Article
    DOI: 10.1159/000490386
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 1482689-6
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  • 2
    Online Resource
    Online Resource
    New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study
    S. Karger AG ; 2020
    In:  Dementia and Geriatric Cognitive Disorders Vol. 49, No. 1 ( 2020), p. 77-90
    Details
    In: Dementia and Geriatric Cognitive Disorders, S. Karger AG, Vol. 49, No. 1 ( 2020), p. 77-90
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 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.
    Type of Medium: Online Resource
    ISSN: 1420-8008 , 1421-9824
    URL: Article
    DOI: 10.1159/000506700
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1482186-2
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  • 3
    Online Resource
    Online Resource
    Delirium Item Bank: Utilization to Evaluate and Create Delirium Instruments
    S. Karger AG ; 2022
    In:  Dementia and Geriatric Cognitive Disorders Vol. 51, No. 2 ( 2022), p. 110-119
    Details
    In: Dementia and Geriatric Cognitive Disorders, S. Karger AG, Vol. 51, No. 2 ( 2022), p. 110-119
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The large number of heterogeneous instruments in active use for identification of delirium prevents direct comparison of studies and the ability to combine results. In a recent systematic review we performed, we recommended four commonly used and well-validated instruments and subsequently harmonized them using advanced psychometric methods to develop an item bank, the Delirium Item Bank (DEL-IB). The goal of the present study was to find optimal cut-points on four existing instruments and to demonstrate use of the DEL-IB to create new instruments. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We used a secondary analysis and simulation study based on data from three previous studies of hospitalized older adults (age 65+ years) in the USA, Ireland, and Belgium. The combined dataset included 600 participants, contributing 1,623 delirium assessments, and an overall incidence of delirium of about 22%. The measurements included the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for delirium, Confusion Assessment Method (long form and short form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (total and severity scores), and Memorial Delirium Assessment Scale (MDAS). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We identified different cut-points for each existing instrument to optimize sensitivity or specificity, and compared instrument performance at each cut-point to the author-defined cut-point. For instance, the cut-point on the MDAS that maximizes both sensitivity and specificity was at a sum score of 6 yielding 89% sensitivity and 79% specificity. We then created four new example instruments (two short forms and two long forms) and evaluated their performance characteristics. In the first example short form instrument, the cut-point that maximizes sensitivity and specificity was at a sum score of 3 yielding 90% sensitivity, 81% specificity, 30% positive predictive value, and 99% negative predictive value. 〈 b 〉 〈 i 〉 Discussion/Conclusion: 〈 /i 〉 〈 /b 〉 We used the DEL-IB to better understand the psychometric performance of widely used delirium identification instruments and scorings, and also demonstrated its use to create new instruments. Ultimately, we hope that the DEL-IB might be used to create optimized delirium identification instruments and to spur the development of a unified approach to identify delirium.
    Type of Medium: Online Resource
    ISSN: 1420-8008 , 1421-9824
    URL: Article
    DOI: 10.1159/000522522
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1482186-2
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    Online Resource
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