The development of a brief confusion screening instrument for the Chinese hospitalized elderly

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The development of a brief confusion screening instrument for the Chinese hospitalized elderly

 

Author: Fung, Oi-kuen
Title: The development of a brief confusion screening instrument for the Chinese hospitalized elderly
Degree: M.Sc.
Year: 2003
Subject: Hong Kong Polytechnic University -- Dissertations
Cognition disorders in old age -- China -- Hong Kong -- Diagnosis
Older people -- Hospital care -- China -- Hong Kong
Geriatric nursing -- China -- Hong Kong
Department: Multi-disciplinary Studies
School of Nursing
Pages: xi, 149 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1686687
URI: http://theses.lib.polyu.edu.hk/handle/200/934
Abstract: In hospitalized older patients, the present of confusion is a significant health problem that required focus assessment and diverse nursing strategies. Early identification of the onset of acute confusion would permit interventions likely to reduce the severity of the confusion and negative consequences. On the other hand, early identification of the insidious chronic confusion would permit better home care planning. The co-existent of acute and chronic confusion on an older patient is common, thus observing both dimensions of confusion features are necessary. The development of the instrument - Brief Confusion Screening for Older People is to facilitate nurses on the problem focus assessment of confused older patients. This tool consists of two constructs to capture the dementia and delirious features since these are the dominant problems leading to confusion. It is a criterion reference measure with the psychometrics of cognition and behavior observation. The items included orientation, recent memory, episodic memory, semantic memory, verbal fluency, perception, thinking, attention, psychomotor activity, sleep-wake cyde, and two differential items on dementia and delirium. The development of instrument required three set of samples. First, the development sample consisted of fifteen hospitalized geriatric patients for the development of the item pool Second, the purposive sample consisted of fifty-three confused geriatric patients with diagnosis of dementia and or delirium. These subjects had participated three screening tests, namely the Brief Confusion Screening for Older People (BCS), the Cantonese Mini-Mental Status Examination (CMMSE), and the Delirium Rating Scale-R-98 (DRS-R-98). The alpha coefficients of internal consistency calculated from this sample was 0.6, and were 0.62 and 0.96 respectively for the dementia construct and delirium construct. Lastly, from a consecutive four days tracing of new admitted geriatric patients; the investigator obtained a convenience sample of seventy-eight subjects to study the item discrimination indices, and concurrent validity. Similar to the purposive sample, the 42 subjects also had the three screening tests. In the BCS instrument, twelve out of the thirteen items acquired adequate item discrimination abilities. The measurement of agreement of the two raters was equal to one. The concurrent validities of the BCS to the CMMSE and DRS-R-98 were excellent with the results equal to -.91 and .85 respectively. For the content validity, this instrument achieved hundred percent of congruency on the relevancy of the items used to screen for confused geriatric patients from a geriatrician, a psychiatrist, and a nurse specialist. Since aging process, physical i1lness, and new environment will affect the cognitive performance and behavior of an older person. The investigator established the norm of cognitive performance and behavior from the population of hospitalized geriatric patients by identifying a standardization sample, and study their BCS score distribution. It was recommended that a geriatric hospitalized patient with BCS confusion score greater than two was suspect to be a confused patient.

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