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

Objectives 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 Fifty‐two family caregivers and 52 elderly adults with preexistin...

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Published inJournal of the American Geriatrics Society (JAGS) Vol. 60; no. 11; pp. 2121 - 2126
Main Authors Steis, Melinda R., Evans, Lois, Hirschman, Karen B., Hanlon, Alexandra, Fick, Donna M., Flanagan, Nina, Inouye, Sharon K.
Format Journal Article
LanguageEnglish
Published Hoboken, NJ Blackwell Publishing Ltd 01.11.2012
Wiley-Blackwell
Wiley Subscription Services, Inc
Subjects
Adult and adolescent clinical studies
Aged
Aged, 80 and over
Biological and medical sciences
caregiver
Caregivers
Cognition & reasoning
Confusion Assessment Method (CAM)
Delirium
Delirium - diagnosis
dementia
Families & family life
Female
General aspects
Humans
Male
Medical sciences
Medical screening
Older people
Organic mental disorders. Neuropsychology
Prevention and actions
Psychiatric Status Rating Scales
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Public health. Hygiene
Public health. Hygiene-occupational medicine
Reproducibility of Results
United States > US
Human
Delirium
Evaluation
Methodology
Family study
Caregiver
Cell adhesion molecule
Method
Medical screening
Organic mental disorder
Test validation
Construct validity
Screening
Convergent validity
Interviewer
Family environment
Confusion Assessment Method (CAM)
Degenerative disease
Elderly
Mental confusion
Dementia
Geriatrics
Online AccessGet full text
ISSN0002-8614
1532-5415
1532-5415
DOI10.1111/j.1532-5415.2012.04200.x

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Abstract Objectives 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 Fifty‐two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing. Measurements The interviewer‐rating for delirium was determined by fulfillment of the CAM algorithm Results The total sample included 52 paired CAM:FAM‐CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47–99%), and specificity of 98% (95% CI = 86–100%). Conclusion The FAM‐CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice.
AbstractList To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings. Exploratory analysis of agreement. Fifty-two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing. The interviewer-rating for delirium was determined by fulfillment of the CAM algorithm The total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47– ;99%), and specificity of 98% (95% CI = 86-100%). The FAM?CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice. 29 references
Objectives 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 Fifty‐two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing. Measurements The interviewer‐rating for delirium was determined by fulfillment of the CAM algorithm Results The total sample included 52 paired CAM:FAM‐CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47–99%), and specificity of 98% (95% CI = 86–100%). Conclusion The FAM‐CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice.
Objectives: 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: Fifty-two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing. Measurements: The interviewer-rating for delirium was determined by fulfillment of the CAM algorithm. Results: The total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47-99%), and specificity of 98% (95% CI = 86-100%). Conclusion: The FAM-CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice. [PUBLICATION ABSTRACT]
To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings. Exploratory analysis of agreement. Community. Fifty-two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing. The interviewer-rating for delirium was determined by fulfillment of the CAM algorithm The total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47-99%), and specificity of 98% (95% CI = 86-100%). The FAM-CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice.
To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings.OBJECTIVESTo explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings.Exploratory analysis of agreement.DESIGNExploratory analysis of agreement.Community.SETTINGCommunity.Fifty-two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing.PARTICIPANTSFifty-two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing.The interviewer-rating for delirium was determined by fulfillment of the CAM algorithmMEASUREMENTSThe interviewer-rating for delirium was determined by fulfillment of the CAM algorithmThe total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47-99%), and specificity of 98% (95% CI = 86-100%).RESULTSThe total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. 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 of 88% (95% CI = 47-99%), and specificity of 98% (95% CI = 86-100%).The FAM-CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice.CONCLUSIONThe FAM-CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice.
Author Evans, Lois
Flanagan, Nina
Hanlon, Alexandra
Hirschman, Karen B.
Fick, Donna M.
Steis, Melinda R.
Inouye, Sharon K.
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  surname: Steis
  fullname: Steis, Melinda R.
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  organization: Department of Veterans Affairs Medical Center, Florida, Orlando
– sequence: 2
  givenname: Lois
  surname: Evans
  fullname: Evans, Lois
  organization: School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia
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  givenname: Karen B.
  surname: Hirschman
  fullname: Hirschman, Karen B.
  organization: School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia
– sequence: 4
  givenname: Alexandra
  surname: Hanlon
  fullname: Hanlon, Alexandra
  organization: School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia
– sequence: 5
  givenname: Donna M.
  surname: Fick
  fullname: Fick, Donna M.
  organization: School of Nursing, Pennsylvania State University, Pennsylvania, University Park
– sequence: 6
  givenname: Nina
  surname: Flanagan
  fullname: Flanagan, Nina
  organization: Decker School of Nursing, Binghamton University, New York, Binghamton
– sequence: 7
  givenname: Sharon K.
  surname: Inouye
  fullname: Inouye, Sharon K.
  organization: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Issue 11
Keywords Human
Delirium
Evaluation
Methodology
Family study
Caregiver
Cell adhesion molecule
Method
Medical screening
Organic mental disorder
Test validation
Construct validity
Screening
Convergent validity
Interviewer
Family environment
Confusion Assessment Method (CAM)
Degenerative disease
Elderly
Mental confusion
Dementia
Geriatrics
Language English
License http://onlinelibrary.wiley.com/termsAndConditions#vor
CC BY 4.0
2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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Fong TG, Jones RN, Shi P et al. Delirium accelerates cognitive decline in Alzheimer disease. Neurology 2009;72:1570-1575.
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Wong CL, Holroyd-Leduc J, Simel DL et al. Does this patient have delirium? Value of bedside instruments JAMA 2010;304:779-786.
Inouye SK, Bogardus ST, Charpentier PA et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-676.
Wei LA, Fearing MA, Sternberg EJ et al. The Confusion Assessment Method: A systematic review of current usage. J Am Geriatr Soc 2008;56:823-830.
Boettger S, Passik S, Breitbart W. Treatment characteristics of delirium superimposed on dementia. Int Psychogeriatr 2011;23:1671-1676.
Wilber ST, Carpenter CR, Hustey FM. The Six-Item Screener to detect cognitive impairment in older emergency department patients. Acad Emerg Med 2008;15:613-616.
Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA 2001;286:2703-2710.
Alzheimer Association. 2011 Alzheimer's diseasefacts and figures. Alzheimers Dement 2011;7:208-244.
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Ely EW, Margolin R, Francis J et al. Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29:1370-1379.
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Feinstein AR. Clinimetrics. New Haven: Yale University Press, 1987.
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Naylor MD, Hirschman KB, Bowles KH et al. Care coordination for cognitively impaired older adults and their caregivers. Home Health Care Serv Q 2007;26:57-78.
Fick DM, Hodo DM, Lawrence F et al. Recognizing delirium superimposed on dementia: Assessing nurses' knowledge using case vignettes. J Gerontol Nurs 2007;33:40-47.
Inouye SK, van Dyck CH, Alessi CA et al. Clarifying Confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med 1990;113:941-948.
Fick D, Foreman M. Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs 2000;26:30-40.
Inouye SK, Ferrucci L. Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. J Gerontol A Biol Sci Med Sci 2006;61A:1277-1280.
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2001; 165
2001; 286
2007; 167
2007; 19
2009; 42
2006; 61A
2000; 26
2002; 50
2006; 10
2010; 304
1999; 340
2008; 15
2008; 56
2003
2012; 16
2001; 29
2007; 33
1998; 64
2011; 7
2009; 72
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2011; 23
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– reference: Wilber ST, Carpenter CR, Hustey FM. The Six-Item Screener to detect cognitive impairment in older emergency department patients. Acad Emerg Med 2008;15:613-616.
– reference: Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA 2001;286:2703-2710.
– reference: Fick D, Kolanowski A, Waller JL et al. Delirium superimposed on dementia in a community-dwelling managed care population: A 3-year retrospective study of occurrence, costs, and utilization. J Gerontol A Biol Sci Med Sci 2005;60A:748-753.
– reference: Naylor MD, Hirschman KB, Bowles KH et al. Care coordination for cognitively impaired older adults and their caregivers. Home Health Care Serv Q 2007;26:57-78.
– reference: Fong TG, Jones RN, Shi P et al. Delirium accelerates cognitive decline in Alzheimer disease. Neurology 2009;72:1570-1575.
– reference: Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. JAMA 1996;275:852-857.
– reference: Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797-811.
– reference: Feinstein AR. Clinimetrics. New Haven: Yale University Press, 1987.
– reference: Netemeyer RG, Bearden WO, Sharma S. Scaling Procedures: Issues and Applications. Thousand Oaks, CA: SAGE Publications, 2003.
– reference: Alzheimer Association. 2011 Alzheimer's diseasefacts and figures. Alzheimers Dement 2011;7:208-244.
– reference: Gaugler JE, Duval S, Anderson KA et al. Predicting nursing home admission in the U.S.: A meta-analysis. BioMed Central 2007;19:7-13.
– reference: Pisani MA, Murphy TE, Van Ness PH et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007;167:1629-1634.
– reference: Inouye SK, van Dyck CH, Alessi CA et al. Clarifying Confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med 1990;113:941-948.
– reference: Inouye SK, Bogardus ST, Charpentier PA et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-676.
– reference: Boettger S, Passik S, Breitbart W. Treatment characteristics of delirium superimposed on dementia. Int Psychogeriatr 2011;23:1671-1676.
– reference: Hestermann U, Backenstrass M, Gekle I et al. Validation of a German version of the Confusion Assessment Method for delirium detection in a sample of acute geriatric patients with a high prevalence of dementia. Psychopathology 2009;42:270-276.
– reference: Margiotta A, Bianchetti A, Ranieri P et al. Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients. J Nutr Health Aging 2006;10:535-539.
– reference: Inouye SK, Ferrucci L. Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. J Gerontol A Biol Sci Med Sci 2006;61A:1277-1280.
– reference: Fick D, Agostini JV, Inouye SK. Delirium superimposed on dementia: A systematic review. J Am Geriatr Soc 2002;50:1723-1732.
– reference: Royall DR, Cordes JA, Polk M. CLOX: An executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:588-594.
– reference: McCusker J, Cole M, Dendukuri N et al. Delirium in older medical inpatients and subsequent cognitive and functional status: A prospective study. Can Med Assoc J 2001;165:575-583.
– reference: Ely EW, Margolin R, Francis J et al. Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29:1370-1379.
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– reference: Fick DM, Hodo DM, Lawrence F et al. Recognizing delirium superimposed on dementia: Assessing nurses' knowledge using case vignettes. J Gerontol Nurs 2007;33:40-47.
– reference: Wilber ST, Lofgren SD, Mager TG et al. An evaluation of two screening tools for cognitive impairment in older emergency department patients. Acad Emerg Med 2005;12:612-616.
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Snippet Objectives To explore agreement between the Family Confusion Assessment Method (FAM‐CAM) for delirium identification and interviewer‐rated CAM delirium...
To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings....
Objectives: To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium...
To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium...
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StartPage 2121
SubjectTerms Adult and adolescent clinical studies
Aged
Aged, 80 and over
Biological and medical sciences
caregiver
Caregivers
Cognition & reasoning
Confusion Assessment Method (CAM)
Delirium
Delirium - diagnosis
dementia
Families & family life
Female
General aspects
Humans
Male
Medical sciences
Medical screening
Older people
Organic mental disorders. Neuropsychology
Prevention and actions
Psychiatric Status Rating Scales
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Public health. Hygiene
Public health. Hygiene-occupational medicine
Reproducibility of Results
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Title Screening for Delirium Using Family Caregivers: Convergent Validity of the Family Confusion Assessment Method and Interviewer-Rated Confusion Assessment Method
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