Dr. Inouye’s groundbreaking research work has focused on delirium and functional decline in hospitalized older patients, resulting in over 70 published articles to date. Her overarching goal has been to translate clinical investigation from its theoretical basis to practical applications that will improve clinical care and quality of life for older persons. Her work has involved applying rigorous clinical epidemiologic and clinical trial methodology to advance the scientific understanding of the diagnosis, etiology, prognosis, prevention, and treatment of delirium. Early in her career, she developed and validated a new instrument for identification of delirium, the Confusion Assessment Method (CAM), which is now the most widely used standard in the field, translated into at least 6 languages. Subsequently, Dr. Inouye helped to conceptualize the multifactorial model for delirium, and focused on identification of predisposing and precipitating factors for delirium. Finally, she developed a multicomponent intervention strategy to prevent delirium, targeted towards six delirium risk factors. This strategy—published in a landmark study in the New England Journal of Medicine—was successful in reducing delirium by 40%, demonstrating for the first time that a substantial proportion of delirium is preventable. A recent study in Medical Care has demonstrated the cost-effectiveness of this intervention strategy. The intervention, called the Hospital Elder Life Program (HELP), is now undergoing national dissemination. Currently, Dr. Inouye is conducting a study examining the pathophysiology of delirium, utilizing neuroimaging (single photon emission computed tomography, SPECT), laboratory markers (e.g., neuron specific enolase and others), and neuropsychological test results—during and after a delirium episode. Other active research areas include the investigation of the long–term outcomes and economic implications of the delirium prevention program, development of strategies for prevention of delirium in the ICU, and development of new screening methods for dementia.
- Pisani MA, Inouye SK, McNicoll L, Redlich CA. Screening for preexisting cognitive impairment in older intensive care unit patients: use of proxy assessment. J Am Geriatr Soc. 2003 51:689-693.
- Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc. 2002 50: 1723-1732.
- Inouye SK, Bogardus ST, Vitagliano G, Desai MM, Williams CS, Grady JN, Scinto JD. The burden of illness score for elderly persons (BISEP): Cumulative impact of diseases, physiologic abnormalities and functional impairments. Medical Care. 2003 41:70-83.
- Inouye SK, Bogardus ST, Williams CS, Leo-Summers L, Agostini JV. The role of adherence on the effectiveness of nonpharmacologic interventions: evidence from the Delirium Prevention Trial. Arch Intern Med. 2003 163:958-964.
- Ely EW, Inouye SK, Gordon S, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Margolin R, Hart RP, Bernard GR. Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001 286:2703-10 (with editorial).