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

Authors


Address correspondence to Dr. Melinda R. Steis, Department of Veterans Affairs, Orlando VA Medical Center, 2900 Veterans Way, Melbourne, FL 32940. E-mail: melinda.steis@va.gov

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.

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