Severe Impairment Rating Scale (SIRS) in assessing patients with severe dementia in Chinese Community

Abstract

AbstractBackgroundLike other advanced countries, Hong Kong is facing the challenges of an aging population, reduced fertility, and increasing longevity. Most older people who diagnosed with moderate to severe dementia would need institutional care. Nevertheless, the current instruments available in the Chinese population are having flooring effects in measuring the functional conditions for this specific group of population.MethodThis study aims to validate the 14‐item Chinese Severe Impairment Rating Scale (C‐SIRS), as an instrument designed to measure functional condition of older people with moderate and severe dementia. The development of this validation study was under classical test theory to examine and test (1) the degree of clarity, understandability, and relevance (i.e. content validity), (2) the test‐retest reliability score of SIRS, (3) the degree of the inter‐relatedness among SIRS items like internal consistency, and (4) the correlation between SIRS score and the functional measures by Hong Kong Montreal Cognitive Assessment (HK‐MoCA) and Modified Barthel Index 100 (MBI‐100).ResultWhen assessing the relevance and sensitivity of the question with the universal agreement calculation method, the scale‐level content validity index (S‐CVI/UA) of C‐SIRS received relevance ratings of “almost agree” or “absolutely agree” by all the experts. The Fleiss' kappa showed that there was moderate agreement between the panellists’ judgements, with at least 8 years of experience, κ = .326 (95% CI, .319 to .343), p < .001. 105 older people with moderate to severe dementia recruited from nursing home were enrolled in the validation, the C‐SIRS had a high level of internal consistency, as determined by a Cronbach’s alpha of 0.99 with F = .005, p = .831. The SIRS shows significant correlation with both cognitive, as measured by MoCA (with r = .337, p < .001), and functional measures as measured by MBI (with r = .64, p < .01).ConclusionC‐SIRS is sensitive in measuring the functional condition in older people with moderate to severe dementia. Moreover, C‐SIRS is easier to administrate with shorter time required. Further study should help by investigating the sensitivity of C‐SIRS to assess the change over a longer period of time.