Detecting delirium in older people: the development of a new web-based tool for family caregiver

Abstract

Background: Delirium, a severe neuropsychiatric syndrome characterized by acute cognitive disturbances and fluctuating consciousness, is common in older adults. Although delirium is diagnosed by clinicians, but the family caregivers are significant and the first people who should identify this condition. However, there are currently no easily accessible and user-friendly tools available for family caregivers to detect delirium in older adults, particularly in Thailand. This study aimed to develop a web-based tool for family caregivers in Thailand to detect delirium in older people. Material and Methods: This was a research and development study. The development process included a literature review, expert interviews, key informant consultations, focus group discussions, expert content validity, and a pilot test of the tool. The final items of the web-based tool named ‘delirium-detect’ included a 22-item symptom checklist that guided family caregivers through questions to assess delirium symptoms accurately, accessible on both personal computers and mobile devices, supporting Thai and English. Additionally, the delirium-detect provides daily homecare guidance and emphasizes early detection. Face and content validity was ensured through expert reviews, resulting in a content validity index of 1.00 (100%). Ordinal scoring was established to gauge the frequency and severity of symptoms. Pretests with 17 participants were conducted to provide feedback for refining the tool. In the final pilot test, 11 participants, all caregivers of older adults diagnosed with delirium, completed the questionnaires and the feasibility test on the website 'delirium-detect. Results: All 11 participants completed the questionnaires, indicating that the older persons they cared for met the criteria for delirium based on DSM-5, suggesting criterion validity However, in the item analysis, 10 out of the 22 items were not endorsed by some respondents (scored “0 (no abnormality)” or not applicable). During the pilot test with 11 participants, the tool was found to be feasible and received high satisfaction rates: 54.5% "Liked" the website, and 18.2% "Liked it a lot." Ease of use was reported as "Very easy" by 36.4% and "Easy" by another 36.4%. Understanding the content was generally high, with 45.5% of participants reporting that they "Well understand" the content and 45.5% indicating that they "Fairly understand" it. Participants spent an average of 9.09 minutes (± 2.10 minutes) using the tool, with the actual questionnaire taking around 5 minutes to complete. Conclusion: The delirium-detect tool proved accurate, practical, user-friendly, and suitable for family caregivers to use to detect delirium. The positive feedback underscores the tool's potential to aid significantly in the early detection of delirium in older adults. Further development and investigation in a larger population are required.