# Measurement in Health: Advancing Assessment of Delirium

> **NIH NIH R36** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2021 · $63,635

## Abstract

Delirium, an acute clinical syndrome characterized by inattention and cognitive disturbances, is a common,
preventable, and costly problem for older persons. Over 3 million people develop delirium annually, accounting
for over $160 billion in annual healthcare expenditures in the United States alone. While prevention of delirium
is possible in up to 30-40% of cases, under-recognition of the syndrome continues to occur in over two-thirds
of cases. A problem plaguing delirium research is difficulty in identification. Clinicians working in different
disciplines have developed many tools to aid in delirium identification across varied clinical settings (for
example, medical units, emergency room, intensive care units). The lack of consensus on key features and
approaches has posed a major barrier to progress in the field of delirium. To address this gap, the overarching
goal of this proposal is to use advanced methods in measurement to improve the identification of delirium.
 The specific aims are to: (1) determine the 4 most commonly used and well-validated instruments for
delirium identification; (2) harmonize the 4 most commonly used and well-validated assessment instruments to
generate an item bank, which is a collection of the individual instrument questions or ratings along with their
parameter estimates from item response theory; (3) identify the threshold (cut-point), which will best identify
delirium (vs. absence of delirium) rates for the harmonized item bank. Accomplishing the first aim will occur
through a rigorous systematic review of the published medical literature with methodologic quality rating of the
articles. The second aim will utilize modern psychometric methods and harmonization methods in a secondary
analysis of the Better Assessment of Illness (BASIL) study and other studies which have simultaneously
administered multiple delirium measures of interest. The third aim will apply simulation methods to identify the
optimal cut-points to determine whether a patient has delirium.
 The significance of the proposed research is the creation of a harmonized item bank to provide a unified
approach to identification of delirium that will help to advance both clinical care and research. The measure will
allow for the comparison of studies regardless of their method of delirium identification. Along with a single
unified measure, crosswalks between delirium measures will be developed. Ultimately, the measure will
facilitate combining studies, paving the way for meta-analyses of existing studies, which are essential for
guideline development and clinical decision-making. Additionally, the harmonized item bank will provide the
means to create big datasets for future largescale pathophysiologic studies (e.g., –omics studies or population-
based investigations) to advance our understanding of molecular, cellular, and physiological mechanisms
underlying delirium. Completion of these projects will help lay the foundation for my future career in ...

## Key facts

- **NIH application ID:** 10104677
- **Project number:** 1R36AG070184-01
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Benjamin Helfand
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $63,635
- **Award type:** 1
- **Project period:** 2021-01-15 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10104677

## Citation

> US National Institutes of Health, RePORTER application 10104677, Measurement in Health: Advancing Assessment of Delirium (1R36AG070184-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10104677. Licensed CC0.

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