Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia

Erika Steensma, Wenxiao Zhou, Long Ngo, Jacqueline Gallagher, Sharon Inouye, Douglas Leslie, Marie Boltz, Ann Kolanowski, Lorraine Mion, Edward R. Marcantonio, Donna Fick

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. Design/Setting/Participants: Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee). Measures: The reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen. Results: Overall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was “What day of the week is it?” with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was “list the days of the week backwards” and “What day of the week is it?” with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was “list the days of the week backwards,” “What type of place is this? [hospital]” and “Does the patient appear sleepy?” with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48). Conclusions/Implications: We identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.

Original languageEnglish (US)
Pages (from-to)1391-1396.e1
JournalJournal of the American Medical Directors Association
Volume20
Issue number11
DOIs
StatePublished - Nov 2019

Fingerprint

Delirium
Dementia
Confidence Intervals
Interviews
Sensitivity and Specificity
Confusion
Hospital Units
Population
Medical Records
Inpatients
Hospitalization
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

Steensma, Erika ; Zhou, Wenxiao ; Ngo, Long ; Gallagher, Jacqueline ; Inouye, Sharon ; Leslie, Douglas ; Boltz, Marie ; Kolanowski, Ann ; Mion, Lorraine ; Marcantonio, Edward R. ; Fick, Donna. / Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia. In: Journal of the American Medical Directors Association. 2019 ; Vol. 20, No. 11. pp. 1391-1396.e1.
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Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia. / Steensma, Erika; Zhou, Wenxiao; Ngo, Long; Gallagher, Jacqueline; Inouye, Sharon; Leslie, Douglas; Boltz, Marie; Kolanowski, Ann; Mion, Lorraine; Marcantonio, Edward R.; Fick, Donna.

In: Journal of the American Medical Directors Association, Vol. 20, No. 11, 11.2019, p. 1391-1396.e1.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia

AU - Steensma, Erika

AU - Zhou, Wenxiao

AU - Ngo, Long

AU - Gallagher, Jacqueline

AU - Inouye, Sharon

AU - Leslie, Douglas

AU - Boltz, Marie

AU - Kolanowski, Ann

AU - Mion, Lorraine

AU - Marcantonio, Edward R.

AU - Fick, Donna

PY - 2019/11

Y1 - 2019/11

N2 - Objective: Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. Design/Setting/Participants: Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee). Measures: The reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen. Results: Overall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was “What day of the week is it?” with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was “list the days of the week backwards” and “What day of the week is it?” with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was “list the days of the week backwards,” “What type of place is this? [hospital]” and “Does the patient appear sleepy?” with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48). Conclusions/Implications: We identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.

AB - Objective: Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. Design/Setting/Participants: Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee). Measures: The reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen. Results: Overall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was “What day of the week is it?” with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was “list the days of the week backwards” and “What day of the week is it?” with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was “list the days of the week backwards,” “What type of place is this? [hospital]” and “Does the patient appear sleepy?” with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48). Conclusions/Implications: We identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.

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