Sharon K. Inouye M.D., M.P.H.

Director, Aging Brain Center and Senior Scientist

Contact Information

Institute for Aging Research
1200 Centre Street
Boston, MA 02131

Phone: 617-971-5390

Fax: 617-971-5309

email: SharonInouye@hsl.harvard.edu

Links

PubMed Articles

Research Interests and Teaching Activities

Dr. Inouye's focus has been to translate the theories of clinical investigation to practical applications that can be used to improve quality of life for older persons. Currently, she is directing the Successful AGing after Elective Surgery (SAGES) study, an $11 million Program Project on Delirium funded by the National Institute on Aging.  The purpose of this study is to examine long-term outcomes of delirium. 

Primary research has focused on delirium and functional decline in hospitalized older patients, resulting in more than 150 published articles and reviews to date. She developed and validated a new instrument for identification of delirium called the Confusion Assessment Method (CAM), which is now the most widely used standard in the field. She also 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 toward six delirium risk factors. This strategy was found to be successful in reducing delirium by 40 percent and was published in a landmark study in the New England Journal of Medicine. This study was the first to show that a substantial proportion of delirium is preventable.

Dr. Inouye now plans to examine the interface of delirium and dementia with multiple studies to investigate whether delirium alters the course of dementia and whether delirium itself leads to longstanding cognitive impairment and pathologic changes in the brain.

Dr. Inouye has been awarded many of the highest accolades in her field, including the American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award (1998), Donaghue Investigator Award (1998-2003), Midcareer Award from the National Institute on Aging (1999-2005), election to the American Society of Clinical Investigation (2002), the Ewald W. Busse Research Award in Biomedical Sciences (Gerontological Society of America, 2003), the UCLA David H. Solomon Award (2005), the 2005 Leonard Tow Humanism in Medicine Award (Arnold P. Gold Foundation),  election to the Yale Society of Distinguished Teachers (2005),  election to the Association of American Physicians and won the 2010 Edward Henderson Award for the American Geriatrics Society. Her work has been continuously funded by the National Institutes of Health since 1991.

Keywords
Delirium, Dementia, Alzheimer's Disease, Acute Confusional State, Geriatric Medicine, Aging Research, Hospital Elder Life Program, Patient Safety, Iatrogenesis

Selected 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 Engl J Med 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.
21. Inouye SK, Bogardus ST, Vitagliano G, Desai MM, Williams CS, Grady JN, Scinto JD. Burden of illness score for elderly persons (BISEP): risk adjustment incorporating the cumulative impact of diseases, physiologic abnormalities and functional impairments. Med Care 2003; 41:70-83.
22. 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.
23. Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers L, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. J Am Geriatr Soc 2005; 53:405-9.
24. Bradley, EH, Webster TR, Baker D, Schlesinger M, Inouye SK. After adoption: sustaining the innovation. A case study of disseminating the Hospital Elder Life Program. J Am Geriatr Soc 2005; 53:1455-1461.
25. Inouye SK, Fiellin DA. An evidence-based guide to writing grant proposals for clinical research. Ann Intern Med 2005; 142:274-82.
26. Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK. Premature death associated with delirium at one year follow-up. Arch Intern Med 2005;165:1657-62.
27. Inouye SK. Current concepts: Delirium in older persons. N Engl J Med 2006; 354:1157-1165.
28. Inouye, SK, Baker DI, Fugal P, Bradley EH. Dissemination of the Hospital Elder Life Program: implementation, adaptation, and successes. J Am Geriatr Soc 2006;54:1492-1499.
29. Inouye SK, Zhang Y, Han L, Leo-Summers L, Jones R, Marcantonio E. Recoverable cognitive dysfunction at hospital admission in older persons during acute illness. J Gen Intern Med 2006;21:1276-1281.
30. Inouye SK, Zhang Y, Jones RN, Kiely DK, Yang F, Marcantonio ER. Risk factors for delirium at hospital discharge: development and validation of a predictive model. Arch Intern Med 2007;167:1406-1413.
31. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007;55:780-791 (with editorial).
32.  Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK.  One-year health care costs associated with delirium in the elderly.  Arch Intern Med. 2008;168:27-32. 
33.  Hshieh TT, Fong TG, Marcantonio ER, Inouye SK.  Cholinergic deficiency hypothesis in delirium:  A synthesis of current evidence.  J Gerontol A Biol Sci Med Sci. 2008; 63A:M764-772.  
34.  Wei LA, Fearing MA, Sternberg E, Inouye SK.  The Confusion Assessment Method (CAM):  A systematic review of current usage.  J Am Geriatr Soc. 2008;56:823-830.  PMC2585541
35. Inouye SK, Zhang Y, Jones RN, Shi P, Cupples LA, Calderon HN, Marcantonio ER.  Risk factors for hospitalization among community-dwelling primary care older patients:  Development and validation of a predictive model.  Med Care. 2008;46:726-731.  PubMed ID: PMC251696
36. Marcantonio ER, Aneja J, Jones RN, Alsop DC, Fong TG, Crosby GJ, Culley DJ, Cupples LA, Inouye SK.  Maximizing clinical research participation in vulnerable older persons: Identification of barriers and motivators. J Am Geriatr Soc 2008; 56: 1522-1527.  PubMed ID: PMC18662204
37. Rudolph JL, Marcantonio ER, Culley DJ, Silverstein JH, Rasmussen LS, Crosby GJ, Inouye SK.  Delirium is associated with early postoperative cognitive dysfunction.  Anaesthesia 2008;63:941-947.  PubMed ID: PMC18547292
38. Yang FM, Inouye SK, Fearing MA, Kiely DK, Marcantonio ER, Jones RN.  Participation in activity and risk for incident delirium.  J Am Geriatr Soc. 2008;56:1479-1484. PubMed ID: PMC18547359
39. Yang F, Marcantonio ER, Inouye SK, Kiely D, Rudolph J, Fearing M, & Jones RN. Phenomenological subtypes of delirium: Patterns, prevalence and prognosis. Psychosomatics, 2009: 50 (3): 248-54. PubMedCentral ID NIHMS71569.
40. Kiely DK, Marcantonio ER, Inouye SK, Shaffer ML, Bergmann MA, Yang FM, Fearing MA, Jones RN.  Persistent delirium predicts increased mortality.  J Am Geriatr Soc. 2009;57:55-61.  
41. Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW, Khuri SF, Lipsitz LA, Ramlawi B, Levitsky S, Marcantonio ER.  Derivation and Validation of a Preoperative Prediction Rule for Delirium after Cardiac Surgery.  Circulation. 2009;119:229-236.
42.  Fong TG, Jones RN, Shi P, Marcantonio ER, Yap L, Rudolph JL, Yang FM, Kiely DK, Inouye SK.  Delirium accelerates cognitive decline in Alzheimer's disease.  Neurology.  2009;72:1570-1575.
43. Pisani MA, Murphy TE, Araujo KL, Slattum P, Van Ness PH, Inouye SK.  Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population.  Crit Care Med. 2009; 37:177-83. PMID: 19050611
44. Fong TG, Fearing MA, Jones RN, Shi P, Marcantonio ER, Rudolph JL, Yang FM, Kiely DK, Inouye SK.  The Telephone Interview for Cognitive Status: Creating a crosswalk with the Mini-Mental State Exam.  Alzheimers Dement 2009; PMID: 19647495.
45. Rubin FH, Neal K, Fenlon K, Hassan S, Inouye SK.  Sustainability and Scalability of the Hospital Elder Life Program (HELP) at a Community Hospital.  J Am Geriatr Soc. 2010.  In Press. 
46. Fong TG, Jones RN, Rudolph JL, Yang FM, Tommet D, Habtemariam D, Marcantonio ER, Langa KM, Inouye SK.  Development and Validation of a Brief Cognitive Assessment Tool:  The Sweet 16.  Arch Intern Med. 2010.  In Press.