谵妄量表：一种用于监测老年患者谵妄严重程度的护士评定量表。

Delirium-O-Meter: a nurses' rating scale for monitoring delirium severity in geriatric patients.

作者信息

de Jonghe Jos F M, Kalisvaart Kees J, Timmers Jannie F M, Kat Martin G, Jackson Jim C

机构信息

Medical Center Alkmaar, Department of Clinical Psychology, Alkmaar, The Netherlands.

出版信息

Int J Geriatr Psychiatry. 2005 Dec;20(12):1158-66. doi: 10.1002/gps.1410.

DOI:10.1002/gps.1410

PMID:16315151

Abstract

BACKGROUND

Delirium is a common psychiatric disorder in general hospital elderly patients. Several delirium screening tests exist. Few nurse based delirium severity measures are available. The aim of this study was to evaluate the Delirium-O-Meter, a new nurses' behavioural rating scale that is an efficient and sensitive measure of delirium severity.

METHODS

Analysis of cross sectional and repeated assessments data. Participants were 92 elderly general hospital patients; 56 with delirium, 24 with dementia or other cognitive disturbances (no delirium) and 12 with other psychiatric disorders or no mental disorder. Measures were the Delirium-O-Meter (DOM), Delirium Rating Scale-Revised version (DRS-R-98), Delirium Observation Scale (DOS), Behavioural observation scale for geriatric inpatients (GIP) and Mini Mental State Examination (MMSE).

RESULTS

The majority of DOM items show a (near-) normal score distribution. Reliability of the DOM was high; Cronbach's alpha values ranged from 0.87-0.92; Intra Class Correlation (ICC) range was 0.84-0.91 for total scores and 0.40-0.97 for item scores. Factor analysis produced a 'Cognitive/Motivational' factor explaining almost half of variance and a smaller 'Psychotic/Behavioural' factor. The two-factor model results support the conceptual distinction between hyperactive and hypoactive delirium. DOM observations differentiated delirium from non delirium patients. DOM total scores were highly related to the DRS-R-98, DOS, MMSE and GIP apathy and cognitive sub scales, but less so to the GIP affective disturbances subscale, indicating convergent and divergent validity. Temporal difference scores calculated for DRS-R-98 and DOM assessments on subsequent days were also highly related (rho = 0.80-0.95).

CONCLUSIONS

The newly constructed DOM is a brief and valid nurses' behavioural rating scale that can be useful for measuring different aspects of delirium and for efficiently monitoring delirium severity in elderly patients.

摘要

背景

谵妄是综合医院老年患者中常见的精神障碍。目前有多种谵妄筛查测试。基于护士的谵妄严重程度测量方法较少。本研究的目的是评估谵妄量表（Delirium - O - Meter），这是一种新的护士行为评定量表，是一种有效且敏感的谵妄严重程度测量方法。

方法

对横断面和重复评估数据进行分析。参与者为92名综合医院老年患者；56名患有谵妄，24名患有痴呆或其他认知障碍（无谵妄），12名患有其他精神障碍或无精神障碍。测量工具包括谵妄量表（DOM）、谵妄评定量表修订版（DRS - R - 98）、谵妄观察量表（DOS）、老年住院患者行为观察量表（GIP）和简易精神状态检查表（MMSE）。

结果

大多数DOM项目显示出（接近）正态分数分布。DOM的信度较高；克朗巴哈系数值范围为0.87 - 0.92；总分的组内相关系数（ICC）范围为0.84 - 0.91，项目分数的ICC范围为0.40 - 0.97。因子分析产生了一个解释近一半方差的“认知/动机”因子和一个较小的“精神病性/行为”因子。双因子模型结果支持了激越性谵妄和安静型谵妄之间的概念区分。DOM观察结果区分了谵妄患者和非谵妄患者。DOM总分与DRS - R - 98、DOS、MMSE以及GIP冷漠和认知子量表高度相关，但与GIP情感障碍子量表相关性较低，表明具有收敛效度和区分效度。后续几天DRS - R - 98和DOM评估的时间差异分数也高度相关（rho = 0.80 - 0.95）。