Confusion Assessment Method
The Confusion Assessment Method (CAM) is a clinical tool designed to help healthcare providers, including those without formal psychology training, detect delirium in patients, particularly in hospital settings. Delirium is characterized by sudden confusion and disordered thinking, often stemming from various medical conditions such as infections, dehydration, or reactions to medications. With over two million cases of delirium reported annually in the U.S., timely identification is crucial, as delirium can lead to severe health complications and increased mortality, especially among the elderly.
Developed in the late 1980s by Dr. Sharon K. Inouye and her team, CAM includes a straightforward set of questions focusing on patients’ cognitive abilities, attention, and awareness of their surroundings. This assessment helps caregivers recognize changes in mental status, enabling them to inform the medical team promptly. By facilitating early detection, CAM plays a vital role in improving patient outcomes, reducing hospital stays, and lowering healthcare costs associated with delirium. Overall, CAM serves as a valuable tool in enhancing the care and recovery prospects for vulnerable patients facing confusion due to acute medical issues.
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Confusion Assessment Method
Confusion assessment method (CAM) is a clinical tool that allows people who are not trained in psychology to detect delirium in medical patients. Delirium often accompanies other health conditions and can result in complications that prevent the patient from making a full recovery. More than two million hospitalized patients affected by delirium each year in the United States alone. The use of CAM can result in significant reductions in delirium-related fatalities and complications, the length of hospitalizations, and medical costs.
Background
Delirium is severe confusion that comes on suddenly, often as a result of a physical or mental illness. It happens when something affects the level of oxygen received by the brain. Infections, fevers, electrolyte imbalances, dehydration, poisons, overdoses of alcohol or drugs (including those used for anesthesia), and severe sleep deprivation can all reduce oxygen and induce delirium. People who have delirium usually cannot think or speak in an organized manner. They may not be able to remember where they are or why they are there and often have difficulty paying attention to what is happening around them.
While it is often temporary, delirium is associated with an increase in conditions that can cause health complications and hasten death. These include dementia, lack of mental function, decreased ability to live independently, and a greater risk of early death. Delirium most commonly affects elderly people who are hospitalized for other conditions. However, some of its symptoms, such as fatigue or sleepiness and confusion, can be mistaken for symptoms of the patient’s primary illness or dismissed as a normal effect of being sedated for a surgical procedure.
Overview
CAM was developed in the late 1980s by medical doctor Sharon K. Inouye and her colleagues. They recognized that the presence of delirium was missed up to 70 percent of the time even though its early detection and treatment improved the odds that a patient would have fewer complications. Inouye and the others developed an assessment tool that could be used by intake people, nurses, and others with no background in psychology to identify patients who were experiencing delirium.
The assessment tool consists of a simple list of questions about the caregiver’s observations about the patient’s condition. The questions address the patient’s ability to think, pay attention, and remember. They assess the extent to which the patient’s ability to perform these actions is affected and whether this changed during the assessment or from previous assessments. It also addresses whether the patient stares blankly or is able to focus on the caregiver and exhibits physical signs of mental agitation such as tapping fingers or tossing about in place.
CAM enables the caregiver to identify the sudden onset of inattention, impaired thinking, or reduced level of consciousness that are the hallmarks of delirium. The caregiver can then alert the patient’s medical team to initiate treatment. The assessment provides an easy and effective way to identify potential problems and initiate a plan to prevent complications resulting from delirium.
Bibliography
“Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium.” Annals of Internal Medicine, 1990, annals.org/aim/article-abstract/704335/clarifying-confusion-confusion-assessment-method-new-method-detection-delirium?doi=10.7326%2F0003-4819-113-12-941. Accessed 1 April 2019.
“Delirium Screening Tool: Confusion Assessment Method (CAM).” Alberta Health Services/Covenant Health, www.albertahealthservices.ca/assets/about/scn/ahs-scn-bjh-hf-delirium-screening-tool.pdf. Accessed 1 April 2019.
“The Impact of Delirium.” NIH Medline Plus, Fall 2015, medlineplus.gov/magazine/issues/fall15/articles/fall15pg16-17.html. Accessed 1 April 2019.
Inouye, Sharon K. et al. “The Confusion Assessment Method (CAM).” Hospital Elder Life Program, 8 Sept. 2014, www.hospitalelderlifeprogram.org/uploads/disclaimers/Long‗CAM‗Training‗Manual‗10-9-14.pdf. Accessed 1 April 2019.
McCabe, Donna. “The Confusion Assessment Method (CAM).” Try This: Best Practices in Nursing Care to Older Adults, 2019, consultgeri.org/try-this/general-assessment/issue-13.pdf. Accessed 1 April 2019.
“The Relationship Between Delirium and Dementia.” Next Avenue, 14 Dec. 2018, www.nextavenue.org/relationship-delirium-dementia/. Accessed 1 April 2019.
“Sharon K. Inouye, M.D., MPH.” Health and Aging Policy Fellows, www.healthandagingpolicy.org/fellows/2016/sharon-k-inouye-m-d-mph/. Accessed 1 April 2019.
Waszynski, Christine M. “Confusion Assessment Method (CAM).” Medscape, 2004, www.medscape.com/viewarticle/481726. Accessed 1 April 2019.