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. 2020 May;68(5):983-990.
doi: 10.1111/jgs.16438. Epub 2020 Apr 10.

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

Tanya Mailhot  1 , Chad Darling  2 , Jillian Ela  3 , Yelena Malyuta  4 , Sharon K Inouye  5   6   7 , Jane Saczynski  1
Affiliations

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

Tanya Mailhot et al. J Am Geriatr Soc. 2020 May.

Abstract

Objective: 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 families' assessments could supplement healthcare professionals' assessments, is promising. J Am Geriatr Soc 68:983-990, 2020.

Keywords: FAM-CAM; delirium; dementia; emergency department; family caregivers.

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Conflict of interest statement

Conflict of interests: TM: no conflicts of interest to declare. CD: no conflicts of interest to declare. JE: no conflicts of interest to declare. YM: no conflicts to declare. SI: no conflicts of interest to declare. JS: no conflicts of interest to declare.

Comment in

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