Three-Minute Assessment Identifies Delirium in Older Adults
Sharon K. Inouye, MD, MPH, a study author and a researcher from the Beth Israel Deaconess Medical Center in Massachusetts, developed the Confusion Assessment Method (CAM) in 1990. In this study, she and her co-authors found the three-minute diagnostic interview for CAM-defined delirium (3D-CAM) was particularly effective in identifying delirium in patients with dementia.
“Hospitals throughout the world are increasingly recognizing the importance of delirium as a major preventable adverse event,” Dr. Inoye said. “The 3D-CAM holds great promise as an important advance for delirium care specifically, and for acute care of elders more generally.”
The researchers noted that estimates indicate more than 2.5 million elderly individuals in the United States may have their hospital stays complicated by delirium, but the condition typically is undetected and can lead to serious complications. In most clinical settings, the average detection rate of delirium is between 12% and 25%, according to the researchers.
This study took place at four general medicine units in an academic medical center and included 201 patients who were at least age 75. The median age was 84, and 28% of patients had dementia.
Each participant in this study received a clinical assessment for delirium and dementia that lasted between 60 and 90 minutes. An expert panel found that 21% of the participants had delirium and 28% had dementia before getting admitted into the hospital.
After the clinical assessment, research assistants administered the 3D-CAM, which consisted of 20 items and only took three minutes on average to complete. The research assistants did not know the results of the clinical assessment.
The researchers found that the 3D-CAM correctly identified 95% of patients with delirium and 94% of patients without delirium.
“As growing numbers of older adults are being hospitalized, it’s critically important that doctors, nurses, and other hospital care providers be able to recognize delirium,” said lead author Edward Marcantonio, MD, SM, Director of the Aging Research Program in the Division of General Medicine and Primary Care at BIDMC and Professor of Medicine at Harvard Medical School. “We wanted to develop a brief and simple method to make this easier to accomplish, and we are extremely happy with the 3D-CAM results.”
