Sharon Inouye, MD, MPH Professor Adjunct Hebrew Senior Life 1200 Centre Street Boston, MA   02131 Phone (617) 363-8020 Fax (617) 363-8901 email: sharoninouye@hrca.harvard.edu

Research Activities

Dr. Inouye is Co-director of the Claude D. Pepper Older Americans Independence Center and the Yale Program on Aging at the Yale School of Medicine. 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.

Dr. Inouye's studies are widely cited, and her work is regularly included in all reviews of the field. She is regularly invited to present her work at national and international forums, and has influenced many other investigators in the direction of their work. She was awarded one of the highest accolades in her field, the 1998 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award, recognizing her contributions to geriatric medicine. Additionally, she received the Donaghue Investigator Award, K24 Midcareer Award from the National Institute on Aging, and the 2002 Novartis Visiting Professorship to Australia.

Selected Recent Publications

1. Inouye SK, Van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990; 113: 941-8.
2. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium among hospitalized elderly persons based on admission characteristics. Ann Intern Med. 1993; 119:474-81.
3. Inouye SK, Acampora D, Miller RL, Fulmer T, Hurst LD, Cooney LM. The Yale Geriatric Care Program: a model of care to prevent functional decline in hospitalized elderly patients. J Amer Geriatr Soc. 1993; 41:1345-52.
4. Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM, Tinetti ME. A controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: The Yale Geriatric Care Program. J Amer Geriatr Soc. 1993; 41:1353-60.
5. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and inter-relationship with baseline vulnerability. JAMA. 1996;275:852-7.
6. Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients: contribution to burden of illness indices. JAMA. 1998;279:1187-1193.
7. Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13:234-242.
8. Inouye SK, Robison JT, Froehlich TE, Richardson ED. The Time and Change Test: a simple screening test for dementia. J Geront Med Sci. 1998; 53A:M281-286.
9. Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM. A clinical trial of a multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine. 1999;340:669-676 (Lead article with editorial)
10. Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med. 1999;106:565-573.
11. Inouye SK. Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Ann Med. 2000;32:257-263.
12. Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM, et al. The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in hospitalized older patients. J Am Geriatr Soc. 2000; 48:1-10 (with editorial)
13. Rizzo JA, Bogardus ST, Leo-Summers L, Williams CS, Acampora D, Inouye SK. A multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Medical Care. 2001;39:740-752
14. Casarett DJ, Inouye SK. Diagnosis and management of delirium near the end of life. Ann Intern Med. 2001; 135:32-40.
15. Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM. Nurses' recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med. 2001;161:2467-2473.
16. 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).
17. 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.
18. 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.
19. Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc. 2002; 50: 1723-1732.
20. 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.