Caregiver identification of delirium: an argument for the implementation of FAM-CAM training
Goulding, Melissa Marie
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BACKGROUND: Delirium is an “acute change in cognition” prevalent in the elderly population (9). It is a clinical diagnosis which results from complex relationships between patient vulnerability and precipitating medical factors (2,9). Delirium has a complex relationship with dementia and often these two cognitive impairments occur together. While delirium occurrence is exceptionally high in dementia patients, it’s recognition by physicians is unfortunately low (10). Delirium prevalence in dementia patients can be as high as 80% and failure to recognize occurs in as many as 75% of cases (10). Recognition of delirium is important due to its association with poor outcomes and potential for prevention by avoiding precipitating causes. Common poor outcomes associated with delirium include, prolonged cognitive and physical impairment, longer hospital stays, institutionalization and death. With the increasing aging population and the rising cost of healthcare in the United States more attention has been focused on better detection of costly conditions including delirium. Efforts have been made to develop tools for universal screening to aid in the recognition of delirium; however, these are not widely used outside of research. One of the challenges in recognizing delirium is that providers lack knowledge of the patient’s baseline cognitive status, making it difficult to determine whether an acute change has occurred. Caregivers are an untapped resource, holding this key piece of information, in the early recognition of delirium. SPECIFIC AIMS: The goal of this study is to build an argument for the implementation of a training program which would teach caregivers to complete the Family Confusion Assessment method (FAM-CAM) interviews on their loved ones at home in an effort to aid in the early recognition of delirium. This will be accomplished through the followings specific aims. Aim 1: Complete a comprehensive literature review to assess the need for family based screening for delirium. An attempt will be made to identify a gap in the literature for efficient and effective delirium screening and utilization of family caregivers. Aim 2: Data collected in a completed prospective observational study “Family Member Identification of Delirium in the Emergency Department” will be analyzed to assess family caregivers’ role in recognition of delirium, and family caregivers’ receptiveness and interest in a training program. METHODS: The information in this thesis used to build the argument for FAM-CAM training was found through a comprehensive review of published literature on delirium. Resources were found mainly through Pub Med and the Hospital Elder Life Program’s Delirium Bibliography. The study; “Family Member Identification of Delirium in the Emergency Department” enrolled 63 patients for CAM only and 108 Dyads for CAM and FAM-CAM with a total N of 171. RESULTS: Results showed that in 60% of cases of delirium that were recognized by physicians, a caregiver was present and provided information on the patient. Without being made aware of potential benefits of FAM-CAM training, 34% of caregivers reported that training on the instrument would be helpful, and 46% showed interest in participating in the training. Concurrent with current research a high percentage of patients with history of dementia were found to be delirious, further exemplifying the link of risk between these two conditions and identifying caregivers of dementia patients as a good population to implement FAM-CAM training. DISCUSSION: This literature review and accompanying study data suggests that, if implemented, FAM-CAM training could lead to potential future benefits including, reduced delirium associated healthcare cost, improved patient outcomes, and an improved experience for caregivers.