Investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the Care Home Setting: The DOSS study


Delirium (an acute confusional state) is a common and serious condition that is associated with increased risk of hospital admission, falls and lasting memory problems. An episode of delirium can be deeply distressing and frightening for the person, their family and their carers.

Many factors may precipitate delirium, for example dehydration, pain, constipation and culprit medications. These risk factors for delirium are particularly prevalent in care homes where residents may be frail, with multiple co-morbidities. Identification of a valid and reliable delirium screening tool that may be used by care home staff as part of routine care would improve the detection of delirium in long term care settings. Early recognition of delirium could facilitate targeting of timely assessment and intervention to identify and modify contributing factors which, left unrecognised, might result in deterioration in health state.

The aim of this study is to investigate whether a simple screening tool for delirium, that has been shown to be reliable in the detection of delirium in the hospital setting, might have utility in the detection of delirium as part of routine care in (UK) care homes, and whether it can be used to assess delirium severity.

The DOSS study is a Prospective observational study. Participating care home residents from four care homes in Leeds / Bradford will be assessed daily for delirium with the DOSS. Diagnostic accuracy of the DOSS for the detection of delirium will be tested against the Confusion Assessment Method completed by trained research assistants. Data collection will occur over nine months.

A reliable method of routine delirium detection in care homes may reduce the impact of an episode of delirium on individuals, their families, and care home staff, offering substantial benefits for the health economy and the wider NHS. Reliable detection of delirium in long-term care settings could form the basis for future delirium research and make delirium a feasible outcome measure for frail older people in this setting.