Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Carpenter, Christopher R.; Banerjee, Jay; Keyes, Daniel C.; Eagles, Debra; Schnitker, Linda; Barbic, David; Fowler, Susan A.; LaMantia, Michael A.

doi:10.1111/acem.13573

Cited by 53 publications

(52 citation statements)

References 92 publications

(128 reference statements)

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“…In fact, most patients presenting to the ED with dementia are previously undiagnosed, so clinicians cannot rely on medical history . Identifying dementia in the ED is as much a challenge as identifying delirium in part because so few ED‐feasible dementia screening instruments exist for emergency medicine …”

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confidence: 99%

Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM‐CAM)

Mailhot

Darling

Ela³

et al. 2020

J American Geriatrics Society

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See related editorial by Kennedy et al. in this issueOBJECTIVE: To examine the ability of the family-rated Family Confusion Assessment Method (FAM-CAM) to identify delirium in the emergency department (ED) among patients with and without dementia, as compared to the reference-standard Confusion Assessment Method (CAM). DESIGN: Validation study. SETTING: Urban academic ED. PARTICIPANTS: Dyads of ED patients, aged 70 years and older, and their family caregivers (N = 108 dyads). MEASUREMENTS: A trained reference standard interviewer performed a cognitive screen, delirium symptom assessment, and scored the CAM. The caregiver self-administered the FAM-CAM. Dementia was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the medical record. For concurrent validity, performance of the FAM-CAM was compared to the CAM. For predictive validity, clinical outcomes (ED visits, hospitalization, and mortality) over 6 months were compared in FAM-CAM positive and negative patients, controlling for age, sex, comorbidity, and cognitive status. RESULTS: Among the 108 patients, 30 (28%) were CAM positive for delirium and 58 (54%) presented with dementia. The FAM-CAM had a specificity of 83% and a negative predictive value of 83%. Most false negatives (n = 9 of 13, 69%) were due to caregivers not identifying the inattention criteria for delirium on the FAM-CAM. In patients with dementia, sensitivity was higher than in patients without (61% vs 43%). In adjusted models, a hospitalization in the following 6 months was more than three times as likely in FAM-CAM positive compared to negative patients (odds ratio = 3.4; 95% confidence interval = 1.2-9.3). CONCLUSIONS: Among patients with and without dementia, the FAM-CAM shows qualities that are important in the ED setting for identification of delirium. Using the FAM-CAM as part of a systematic screening strategy for the ED, in which familiesʼ assessments could supplement healthcare professionalsʼ assessments, is promising. J Am Geriatr Soc 00:983-990, 2020. D elirium, an acute decline in cognitive function, is common among hospitalized older patients and is associated with poor clinical and functional outcomes. 1 The emergency department (ED) is the point of hospital entry for the vast majority of inpatients, and up to 20% of older patients in the ED have prevalent delirium. 2 Patients with delirium in the ED are at risk for poor outcomes, including longer and more complicated hospital stays, slower functional recovery, and readmission. 3 More important, patients discharged home with delirium have a high mortality rate. 4 Despite its high prevalence, delirium often goes undiagnosed in the ED, even though it is included in quality indicators, emergency medicine resident core competencies, and guidelines. 2,[5][6][7][8] In the context of the ED, identifying delirium is a primary concern; and since longer duration of delirium is associated with poorer outcomes, early identification is key. 3,4 Moreover, many older patients in the ED have dementia, which is a le...

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confidence: 99%

Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM‐CAM)

Mailhot

Darling

Ela³

et al. 2020

J American Geriatrics Society

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“…Cognitive ability was first assessed with the Abbreviated Mental Test 4 (AMT4). An AMT4 score of 3 or less has a sensitivity of 74% and a specificity of 88% for detecting cognitive impairment among ED patients aged 65 years or older . Patients with AMT4 scores of 3 or less completed the Mini‐Mental State Examination (MMSE), which was purchased from Psychologic Assessment Resources…”

Section: Methodsmentioning

confidence: 99%

“…An AMT4 score of 3 or less has a sensitivity of 74% and a specificity of 88% for detecting cognitive impairment among ED patients aged 65 years or older. 9 Patients with AMT4 scores of 3 or less completed the Mini-Mental State Examination (MMSE), which was purchased from Psychologic Assessment Resources. 18 All patients responded to an elder abuse screen consisting of 15 questions designed to detect physical abuse, psychological abuse, financial abuse, and neglect.…”

Section: Methodsmentioning

confidence: 99%

“…One important component of an ED‐based elder abuse screening tool is an efficient method of determining whether the patient can accurately report abuse. This challenge is particularly salient in the ED, where an estimated 31% of older adult patients have some degree of cognitive impairment . A recent study found that many adults with dementia, in addition to being aware of their own cognitive impairment, can accurately recall and describe emotional experiences even after a time delay and without cues, suggesting that many cognitively impaired older adults have the ability to accurately report abuse.…”

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confidence: 99%

“…This challenge is particularly salient in the ED, where an estimated 31% of older adult patients have some degree of cognitive impairment. [9][10][11] A recent study found that many adults with dementia, in addition to being aware of their own cognitive impairment, can accurately recall and describe emotional experiences even after a time delay and without cues, 12 suggesting that many cognitively impaired older adults have the ability to accurately report abuse. Nonetheless, a better understanding of which patients can and cannot report abuse is needed to ensure effective and efficient comprehensive screening.…”

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confidence: 99%

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Ability of Older Adults to Report Elder Abuse: An Emergency Department–Based Cross‐Sectional Study

Richmond

Zimmerman

Reeve

et al. 2020

J American Geriatrics Society

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OBJECTIVES To characterize assessments of a patient's ability to report elder abuse within the context of an emergency department (ED)–based screen for elder abuse. DESIGN Cross‐sectional study in which participants were screened for elder abuse and neglect. SETTING Academic ED in the United States. PARTICIPANTS Patients, aged 65 years and older, presenting to an ED for acute care were assessed by trained research assistants or nurses. MEASUREMENTS All patients completed the four‐item Abbreviated Mental Test 4 (AMT4), then completed a safety interview (using the Emergency Department Senior Abuse Identification tool) designed to detect multiple domains of elder abuse and received a physical examination. Based on the cognitive assessment and safety interview, assessors ranked their confidence in the patient's ability to report abuse as absolutely confident, confident, somewhat confident, or not confident. To assess interrater reliability, two assessors independently rated confidence for a subset of patients. RESULTS Assessors suspected elder abuse in 18 of 276 patients (6.5%). Assessors were absolutely confident in the patient's ability to report abuse for 95.7% of patients, confident for 2.5%, somewhat confident for 1.5%, and not confident for 0.3%. Among patients with an AMT4 of 4 (n = 249), assessors were confident or absolutely confident in 100% of patients. Among patients with an AMT4 of less than 4 (n = 27), they were confident or absolutely confident in the patient's ability to report abuse for 81% of patients, including 11 of 12 patients with mild cognitive impairment and 7 of 11 patients with severe cognitive impairment. For patients receiving paired evaluations (n = 131), agreement between assessors regarding patient ability to report abuse was 97% (κ = 0.5). CONCLUSIONS In this sample of older adults receiving care in an ED, research assistants and nurses felt that the vast majority were able to report elder abuse, including many patients with cognitive impairment. J Am Geriatr Soc 68:170–175, 2019

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Geriatric Screening

Bellolio

2023

Evidence‐Based Emergency Care

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Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Cited by 53 publications

References 92 publications

Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM‐CAM)

Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM‐CAM)

Ability of Older Adults to Report Elder Abuse: An Emergency Department–Based Cross‐Sectional Study

Geriatric Screening

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