Screening for Delirium Using Family Caregivers: Convergent Validity of the Family Confusion Assessment Method and Interviewer‐Rated Confusion Assessment Method

Abstract

Background/Objectives As the population ages, delirium superimposed on dementia is becoming a common problem. Family caregivers may provide critical information to assist with early detection. The purpose of this study was to explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings. Design Exploratory analysis of agreement. Setting Community. Participants 52 family caregivers and 52 elders with pre-existing impairment on standardized cognitive testing. Measurements The interviewer-rating for delirium was determined by fulfillment of the Confusion Assessment Method (CAM) algorithm. Results The total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elders with pre-existing cognitive impairment and family caregivers. The point prevalence of delirium was (7/52)13%. Characteristics did not differ significantly between the delirium and non-delirium groups. The FAM-CAM questions that mapped directly to the original four-item CAM algorithm had the best overall agreement with the interviewer-rated CAM, kappa=0.85 (95% confidence interval, CI 0.65–1.0), sensitivity 88% (CI 47–99%) and specificity 98% (CI 86–100%). Conclusion The FAM-CAM is a sensitive screening tool for detection of delirium in elders with cognitive impairment utilizing family caregivers, with relevance for both research and clinical practice.

Patients prone for postoperative delirium

“…Based on the Confusion Assessment Method (CAM) for nonintubated patients, the 3D-CAM was developed as a diagnostic algorithm using operationalized features to quicker diagnose or exclude POD in patients [12]. Other new tools, such as the FAM-CAM, help in identifying delirium by interviewing family members [13], the CAM-S serves as a delirium severity measure [14], and the mCAM-ED allows for screening for delirium in emergency departments [15].…”

We can Do it: Nursing Educational Intervention to Increase Delirium Documentation

“…Worldwide, the CAM has been validated in many clinical settings and has been translated into more than 20 different languages [12,[14][15][16]. Subsequent adaptations of the CAM have included a longer version (Long CAM), CAM for the Intensive Care Unit (CAM-ICU), Family CAM (FAM-CAM), CAM severity score (CAM-S), and the 3-minute diagnostic assessment (3D-CAM) [17][18][19][20][21][22].…”

Family Recognition of Delirium in Post-acute Care

“…They are inattention, disorganized thinking, altered level of consciousness, disorientation, perceptual disturbances (such as hallucinations), and inappropriate behavior or agitation. 10 Cognitive impairment was measured using the Modifi ed Mini-Cog test. The Mini-Cog is a composite of a 3-item recall and clock drawing.…”