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Study protocol—investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the care home setting: a prospective cohort study
  1. Elizabeth Teale1,
  2. John Young1,
  3. Najma Siddiqi2,
  4. Theresa Munyombwe3,
  5. Jennifer Harrison4,
  6. Marieke Schuurmanns5
  1. 1Academic Unit of Elderly Care and Rehabilitation, Leeds University, Bradford, UK
  2. 2Academic Unit of Psychiatry and Behavioural Sciences, Leeds University and Bradford District Care NHS Foundation Trust, Leeds, UK
  3. 3Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, Leeds, UK
  4. 4Centre for Cognitive Ageing and Cognitive Epidemiology and the Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
  5. 5Department of Rehabilitation, University Medical Center, Utrecht, Netherlands
  1. Correspondence to Dr Elizabeth Teale; Elizabeth.Teale{at}


Introduction Delirium is a common and distressing condition associated with frailty, dementia and comorbidity. These are common in long-term care settings. Residents in care homes are therefore at particular risk of delirium. Despite this, methods to detect delirium in care homes are lacking, with existing diagnostic tools taking too long, or requiring specific training to deliver. This limits their feasibility for use for the routine detection of delirium by care home staff. Routine screening for delirium in care homes would allow timely attention to exacerbating factors to attenuate the episode, and facilitate future research into delirium in the care home environment.

Methods Residents from 4 large care homes will be asked to consent (or their consultees asked to provide a declaration of agreement) to participate in the study. Care home staff will administer the 25-item Delirium Observation Screening Scale (DOSS)—a delirium screening tool based on observed behaviours—and this will be tested against the research standard Confusion Assessment Method (CAM) administered by trained research assistants performed two times per week for all participating residents.

Analysis Sensitivity, specificity, positive and negative predictive values, likelihood ratios and a diagnostic OR will be calculated for the detection of delirium with the 25-item DOSS. The feasibility of routine delirium screening and the scaling properties of the 25-item DOSS will also be explored.

Ethics and Dissemination For residents lacking capacity to participate, a consultee will be approached for a declaration of agreement for inclusion in the study. Results will be published in peer-reviewed journals and disseminated in written format to clinical commissioning groups, general practitioners and relevant third parties.

Trial registration number ISRCTN14608554.

  • Delirium & cognitive disorders < PSYCHIATRY
  • Care Homes
  • Diagnosis

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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