Cam tool for delirium

Copyright , , Hospital Elder Life Program. Not to be reproduced without permission. Member Portal Join. Link to tools Confusion Assessment Method CAM-long The Confusion Assessment Method is a item tool that is the gold standard for delirium identification including diagnosis, severity, and behavioral subtype. Link to tools Delirium Burden Instruments The Delirium Burden instruments are designed to measure distress due to delirium in Patient and Caregivers and to be used as a means of quantifying the burden of an acute delirium episode lasting hours to days.

Link to tools Confusion Assessment Method. To date, 11 published studies have evaluated the performance characteristics of the CAM compared with reference standard ratings. Interrater reliability kappa 0. The CAM has been translated into 10 languages where published articles are available. A significant shortcoming of these studies is that not all of the adaptations or translations have been validated against a reference standard to determine their psychometric properties.

This will be an important area for future research. In over application studies, we have documented that the CAM is widely used for both clinical and research applications. Based on this review, several recommendations are proposed to optimize the use of the CAM for the identification of delirium.

Some training is recommended for optimal use. Without such formal assessment or with extremely brief assessments , the sensitivity of the CAM for delirium detection is compromised.

For research purposes, use of the full 9-item CAM instrument is recommended to maximize sensitivity for the detection of delirium. An important caveat about use of the CAM is worthy of comment. Given its imperfect sensitivity, we do not recommend the CAM as the sole means for identification of delirium in the clinical setting. The use of astute clinical judgment combined with other formal cognitive screening measures is required to avoid missing hypoactive, subtle, or atypical cases of delirium.

This systematic review has helped to uncover gaps in our knowledge base regarding the CAM and to define critical areas where further research is needed. Future work should focus on defining the optimal brief assessment to score the CAM.

Based on recent studies 48 , this assessment is likely to require assessment of sustained attention and executive functioning; nonverbal assessments, such as used for the CAM-ICU, are not ideal in verbal patients In addition, application of combined methods may help to maximize the sensitivity of the CAM for detection of delirium, e.

Identification of key features that distinguish delirium from dementia at the bedside may help to improve the specificity of the CAM. Future work is needed to validate the use of CAM summary scores or adaptations to measure delirium severity, and to correlate these scores with outcomes.

Finally, testing educational efforts to improve the identification of delirium with the CAM features among physicians and nurses are greatly needed. Despite use of the CAM, the serious and persistent lack of recognition of delirium in clinical settings remains a fundamental problem. Systematic, widespread changes in our approaches to care of older persons will be needed to make substantial impact on the devastating problem of delirium in this population.

The authors thank Ms. Sarah Dowal and Ms. Jasneet Aneja for assistance with manuscript preparation. This paper is dedicated to Ben and Jordan Helfand. Inouye holds the Milton and Shirley F. Levy Family Chair. Financial Disclosure: The authors have no financial conflicts of interest to disclose. National Center for Biotechnology Information , U. J Am Geriatr Soc. Author manuscript; available in PMC May 1. Leslie A. Wei , B. Fearing , Ph. Sternberg , 4 and Sharon K. Inouye , M.

Michael A. Eliezer J. Sharon K. Author information Copyright and License information Disclaimer. Address correspondence to: Sharon K. Inouye, M. Alternate corresponding author: Michael A.

Fearing, Ph. Copyright notice. The publisher's final edited version of this article is available at J Am Geriatr Soc. See other articles in PMC that cite the published article. Abstract Objectives To examine the psychometric properties, adaptations, translations, and applications of the Confusion Assessment Method CAM , a widely-used instrument and diagnostic algorithm for identification of delirium. Design Systematic literature review. Conclusions The CAM has helped to improve identification of delirium in clinical and research settings.

Keywords: Delirium, systematic review, dementia, older persons, Confusion Assessment Method. Open in a separate window. Figure 1. Results Of the final articles, 11 4. Table 2 CAM Adaptations. Translations The CAM has been translated into 10 languages Table 3 7 — 9 , 32 — 40 where published studies are available. Applications The CAM is widely used in both research and clinical settings. Discussion This article provides a systematic review of the usage of the CAM over the past 16 years.

Acknowledgments The authors thank Ms. Footnotes Financial Disclosure: The authors have no financial conflicts of interest to disclose. References 1. Recovery and outcome of delirium in elderly medical inpatients. Arch Gerontol Geriatr. Inouye SK. Current concepts: delirium in older persons.

N Engl J Med. Clarifying confusion: the Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. Feinstein AR. New Haven: Yale University Press; Instrument for detection of delirium in general hospitals: adaptation of the confusion assessment method.

Confusion assessment method in the diagnostics of delirium among aged hospital patients: Would it serve better in screening than as a diagnostic instrument? Int J Geriatr Psychiatry. Validity and reliability of the Portuguese version of the Confusion Assessment Method CAM for the detection of delirium in the elderly. Arq Neuropsiquiatr. Gen Hosp Psychiatry. Validity of the confusion assessment method in detecting postoperative delirium in the elderly. Int Psychogeriatr. Detection and diagnosis of delirium in the elderly: psychiatrist diagnosis, confusion assessment method, or consensus diagnosis?

Tullmann, D. Boltz, E. Capezuti, T. Zwicker Eds. Vasilevskis, E. Delirium and sedation recognition using validated instruments: Reliability of bedside intensive care unit nursing assessments from to ConsultGeri Try This: Series. Issue 13 of General Assessment Series. Try This PDF. How To Try This Video:. How To Try This Article:. Protocols Assessing Cognition. Elder Mistreatment EM. Fall Prevention. Frailty and its Implications for Care. General Surgical Care.

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