Yang, Frances Margaret

Person:
Yang, Frances Margaret

Last Name

Yang

First Name

Frances Margaret

Name

Yang, Frances Margaret

Full item page

Search Results

Now showing 1 - 9 of 9

Phenomenological Subtypes of Delirium in Older Persons: Patterns, Prevalence, and Prognosis
(Elsevier BV, 2009) Yang, Frances Margaret; Marcantonio, Edward; Inouye, Sharon; Kiely, Dan K.; Rudolph, James; Fearing, Michael A.; Jones, Richard Norman
Persistent Delirium Predicts Greater Mortality
(Wiley-Blackwell, 2009) Kiely, Dan K.; Marcantonio, Edward; Inouye, Sharon; Shaffer, Michele L.; Bergmann, Margaret A.; Yang, Frances Margaret; Fearing, Michael A.; Jones, Richard Norman
OBJECTIVES: To examine the association between persistent delirium and 1-year mortality in newly admitted post-acute care (PAC) facility patients with delirium who were followed regardless of residence. DESIGN: Observational cohort study. SETTING: Eight greater-Boston skilled nursing facilities specializing in PAC. PARTICIPANTS: Four hundred twelve PAC patients with delirium at admission after an acute hospitalization. MEASUREMENTS: Assessments were done at baseline and four follow-up times: 2, 4, 12, and 26 weeks. Delirium, defined using the Confusion Assessment Method, was assessed, as were factors used as covariates in analyses: age, sex, comorbidity, functional status, and dementia. The outcome was 1-year mortality determined according to the National Death Index and corroborated using medical record and proxy telephone interview. RESULTS: Nearly one-third of subjects remained delirious at 6 months. Cumulative 1-year mortality was 39%. Independent of age, sex, comorbidity, functional status, and dementia, subjects with persistent delirium were 2.9 (95% confidence interval=1.9–4.4) times as likely to die during the 1-year follow-up as subjects whose delirium resolved. This association remained strong and significant in groups with and without dementia. Additionally, when delirium resolved, the risk of death diminished thereafter. CONCLUSION: In patients who were delirious at the time of PAC admission, persistent delirium was a significant independent predictor of 1-year mortality.
Telephone Interview for Cognitive Status: Creating a crosswalk with the Mini-Mental State Examination
(Elsevier BV, 2009) Fong, Tamara; Fearing, Michael A.; Jones, Richard Norman; Shi, Peilin; Marcantonio, Edward; Rudolph, James; Yang, Frances Margaret; Kiely, Dan K.; Inouye, Sharon
Background Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function. Methods The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination. Results Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively. Conclusions These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.
Aging, brain disease, and reserve: Implications for delirium
(2010) Jones, Richard Norman; Fong, Tamara; Metzger, Eran; Tulebaev, Samir; Yang, Frances Margaret; Alsop, David; Marcantonio, Edward; Cupples, L; Gottlieb, Gary; Inouye, Sharon
Cognitive and brain reserve are well studied in the context of age-associated cognitive impairment and dementia. However, there is a paucity of research that examines the role of cognitive or brain reserve in delirium. Indicators (or proxy measures) of cognitive or brain reserve (such as brain size, education, and activities) pose challenges in the context of the long prodromal phase of Alzheimer disease but are diminished in the context of delirium, which is of acute onset. This article provides a review of original articles on cognitive and brain reserve across many conditions affecting the central nervous system, with a focus on delirium. The authors review current definitions of reserve. The authors identify indicators for reserve used in earlier studies and discuss these indicators in the context of delirium. The authors highlight future research directions to move the field ahead. Reserve may be a potentially modifiable characteristic. Studying the role of reserve in delirium can advance prevention strategies for delirium and may advance knowledge of reserve and its role in aging and neuropsychiatric disease generally.
Development of a unidimensional composite measure of neuropsychological functioning in older cardiac surgery patients with good measurement precision
(Informa UK Limited, 2010) Jones, Richard Norman; Rudolph, James; Inouye, Sharon; Yang, Frances Margaret; Fong, Tamara; Milberg, William; Tommet, Douglas; Metzger, Eran; Cupples, L. Adrienne; Marcantonio, Edward
The objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods. Factor analysis methods based on item response theory were used to evaluate the measure. Modified parallel analysis supported a single factor, and the battery formed an internally consistent set (coefficient alpha = .82). The developed measure provided a reliable, continuous measure (reliability > .90) across a broad range of performance (–1.5 SDs to +1.0 SDs) with minimal ceiling and floor effects.
Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery
(Wiley-Blackwell, 2010) Rudolph, James; Inouye, Sharon; Jones, Richard N.; Yang, Frances Margaret; Fong, Tamara; Levkoff, Sue; Marcantonio, Edward
OBJECTIVES: To determine whether patients who developed delirium after cardiac surgery were at risk of functional decline. DESIGN: Prospective cohort study. SETTING: Two academic hospitals and a Veterans Affairs Medical Center. PARTICIPANTS: One hundred ninety patients aged 60 and older undergoing elective or urgent cardiac surgery. MEASUREMENTS: Delirium was assessed daily and was diagnosed according to the Confusion Assessment Method. Before surgery and 1 and 12 months postoperatively, patients were assessed for function using the instrumental activities of daily living (IADL) scale. Functional decline was defined as a decrease in ability to perform one IADL at follow-up. RESULTS: Delirium occurred in 43.1% (n=82) of the patients (mean age 73.7±6.7). Functional decline occurred in 36.3% (n=65/179) at 1 month and in 14.6% (n=26/178) at 12 months. Delirium was associated with greater risk of functional decline at 1 month (relative risk (RR)=1.9, 95% confidence interval (CI)=1.3–2.8) and tended toward greater risk at 12 months (RR=1.9, 95% CI=0.9–3.8). After adjustment for age, cognition, comorbidity, and baseline function, delirium remained significantly associated with functional decline at 1 month (adjusted RR=1.8, 95% CI=1.2–2.6) but not at 12 months (adjusted RR=1.5, 95% CI=0.6–3.3). CONCLUSION: Delirium was independently associated with functional decline at 1 month and had a trend toward association at 12 months. These findings provide justification for intervention trials to evaluate whether delirium prevention or treatment strategies might improve postoperative functional recovery.
Risk Factors for Delirium at Discharge
(American Medical Association (AMA), 2007) Inouye, Sharon; Zhang, Ying; Jones, Richard Norman; Kiely, Dan K.; Yang, Frances Margaret; Marcantonio, Edward
Developing an African youth psychosocial assessment: an application of item response theory
(Wiley-Blackwell, 2014) Betancourt, Theresa; Yang, Frances Margaret; Bolton, Paul; Normand, Sharon-Lise
This study aimed to refine a dimensional scale for measuring psychosocial adjustment in African youth using item response theory (IRT). A 60-item scale derived from qualitative data was administered to 667 war-affected adolescents (55% female). Exploratory factor analysis (EFA) determined the dimensionality of items based on goodness-of-fit indices. Items with loadings less than 0.4 were dropped. Confirmatory factor analysis (CFA) was used to confirm the scale's dimensionality found under the EFA. Item discrimination and difficulty were estimated using a graded response model for each subscale using weighted least squares means and variances. Predictive validity was examined through correlations between IRT scores (θ) for each subscale and ratings of functional impairment. All models were assessed using goodness-of-fit and comparative fit indices. Fisher's Information curves examined item precision at different underlying ranges of each trait. Original scale items were optimized and reconfigured into an empirically-robust 41-item scale, the African Youth Psychosocial Assessment (AYPA). Refined subscales assess internalizing and externalizing problems, prosocial attitudes/behaviors and somatic complaints without medical cause. The AYPA is a refined dimensional assessment of emotional and behavioral problems in African youth with good psychometric properties. Validation studies in other cultures are recommended.
Selecting Optimal Screening Items for Delirium: An Application of Item Response Theory
(BioMed Central, 2013) Yang, Frances Margaret; Jones, Richard Norman; Inouye, Sharon; Tommet, Douglas; Crane, Paul K; Rudolph, James; Ngo, Long; Marcantonio, Edward
Background: Delirium (acute confusion), is a common, morbid, and costly complication of acute illness in older adults. Yet, researchers and clinicians lack short, efficient, and sensitive case identification tools for delirium. Though the Confusion Assessment Method (CAM) is the most widely used algorithm for delirium, the existing assessments that operationalize the CAM algorithm may be too long or complicated for routine clinical use. Item response theory (IRT) models help facilitate the development of short screening tools for use in clinical applications or research studies. This study utilizes IRT to identify a reduced set of optimally performing screening indicators for the four CAM features of delirium. Methods: Older adults were screened for enrollment in a large scale delirium study conducted in Boston-area post-acute facilities (n = 4,598). Trained interviewers conducted a structured delirium assessment that culminated in rating the presence or absence of four features of delirium based on the CAM. A pool of 135 indicators from established cognitive testing and delirium assessment tools were assigned by an expert panel into two indicator sets per CAM feature representing (a) direct interview questions, including cognitive testing, and (b) interviewer observations. We used IRT models to identify the best items to screen for each feature of delirium. Results: We identified 10 dimensions and chose up to five indicators per dimension. Preference was given to items with peak psychometric information in the latent trait region relevant for screening for delirium. The final set of 48 indicators, derived from 39 items, maintains fidelity to clinical constructs of delirium and maximizes psychometric information relevant for screening. Conclusions: We identified optimal indicators from a large item pool to screen for delirium. The selected indicators maintain fidelity to clinical constructs of delirium while maximizing psychometric information important for screening. This reduced item set facilitates development of short screening tools suitable for use in clinical applications or research studies. This study represents the first step in the establishment of an item bank for delirium screening with potential questions for clinical researchers to select from and tailor according to their research objectives.