Construction and initial validation of a new tool for the hetero-evaluation of sleep disturbance risk in hospitalized older adults: The Biazzi scale

BACKGROUND: Hospitalization increases older adults' vulnerability to sleep disorders, yet their assessment in hospital settings remains challenging due to the limitations of self-report tools. This study describes the development and validation of the Biazzi Scale, a clinician-administered instrument designed to identify sleep disturbance risk in hospitalized older adults. METHODS: The study was conducted in two phases. In the first phase, scale items were developed through a literature review and expert consultation, and content validity was assessed using the Item-Level Content Validity Index (I-CVI) and the Scale-Level Content Validity Index (S-CVI). In the second phase, the Biazzi Scale was administered to 150 patients aged ≥65 years hospitalized in four wards of the Piacenza Local Health Authority. Inter-rater reliability was evaluated using Cohen's Kappa. Functional convergent validity at the level of clinical classification was examined through Receiver Operating Characteristic (ROC) analysis using the Pittsburgh Sleep Quality Index (PSQI) as an external reference. RESULTS: Content validity was satisfactory (I-CVI ≥0.78; S-CVI = 0.90), and inter-rater reliability was good (κ = 0.77). ROC analysis demonstrated adequate classification performance, with an optimal cut-off score of 6. Sleep disturbance risk differed significantly across hospital wards and between genders, with higher risk observed among female patients. CONCLUSION: The Biazzi Scale is a reliable and clinically applicable tool for identifying sleep disturbance risk in hospitalized older adults. IMPLICATIONS FOR PRACTICE: The scale supports early risk screening and may prompt further individualized clinical assessment to inform clinical decision-making during hospitalization.