Confusion Assessment Method (CAM)

Todays post is part of our ongoing series, The Encompass Way. Here, we’ll go over many of the steps involved in setting up a comprehensive care plan, which helps us to provide seniors and their families a complete understanding of the available care options and helps them maneuver through the challenges of the system.

home care omahaWhen applicable, Encompass Senior Solutions uses the Confusion Assessment Method (CAM) to identify possible delirium in a patient. This is an important test because, according to research, around 15-60 percent of elderly patients experience some form of delirium prior to or during hospitalization, but sadly this goes undiagnosed 70 percent of the time. If you’re a caregiver and notice that your loved one seems confused, inattentive or even a little off, it’s important to make note of the symptoms and report them to a healthcare professional.

INSTRUCTIONS

This form assesses the following factors:

Acute Onset

1. Is there evidence of an acute change in mental status from the patient’s baseline?

  • Yes
  • No
  • Uncertain
  • Not applicable

Inattention

(The questions listed under this topic are repeated for each topic where applicable.)

2A. Did the patient have difficulty focusing attention (for example, being easily distractible or having difficulty keeping track of what was being said)?

  • Not present at any time during interview
  • Present at some time during interview, but in mild form
  • Present at some time during interview, in marked form
  • Uncertain

2B. (If present or abnormal) Did this behavior fluctuate during the interview (that is, tend to come and go or increase and decrease in severity)?

  • Yes
  • No
  • Uncertain
  • Not applicable

2C. (If present or abnormal) Please describe this behavior.

______________

Disorganized Thinking

3. Was the patient’s thinking disorganized or incoherent such as rambling or irrelevant conversation, unclear or illogical flow of ideas or unpredictable, switching from subject to subject?

  • Yes
  • No
  • Uncertain
  • Not applicable

Altered Level of Consciousness

4. Overall, how would you rate this patient’s level of consciousness?

  • Alert (normal)
  • Vigilant (hyperalert, overly sensitive to environmental stimuli, startled very easily)
  • Lethargic (drowsy, easily aroused)
  • Stupor (difficult to arouse)
  • Coma (unarousable)
  • Uncertain

Disorientation

5. Was the patient disoriented at any time during the interview such as thinking that he or she was somewhere other than the hospital, using the wrong bed or misjudging the time of day?

  • Yes
  • No
  • Uncertain
  • Not applicable

Memory Impairment

6. Did the patient demonstrate any memory problems during the interview such as inability to remember events in the hosptial or difficulty remembering instructions?

  • Yes
  • No
  • Uncertain
  • Not applicable

Perceptual Disturbances

7. Did the patient have any evidence of perceptual disturbances such as hallucinations, illusions or misinterpretations (for example, thinking something was moving when it was not)?

  • Yes
  • No
  • Uncertain
  • Not applicable

Psychomotor Agitation

8A. At any time during the interview did the patient have an unusually increased level of motor activity such as restlessness, picking at bedclothes, tapping fingers or making frequent, sudden changes in position?

  • Yes
  • No
  • Uncertain
  • Not applicable

Psychomotor Retardation

8B. At any time during the interview did the patient have an usually decreased level of motor activity such as sluggishness, staring into space, staring in one position for a long time or moving very slowly?

  • Yes
  • No
  • Uncertain
  • Not applicable

Altered Sleep-Wake Cycle

9. Did the patient have evidence of disturbance of the sleep-wake cycle such as excessive daytime sleepiness with insomnia at night?

  • Yes
  • No
  • Uncertain
  • Not applicable

SCORING

For a diagnosis of delirium by CAM, the patient must display:

1. Presence of acute onset and fluctuating discourse

AND

2. Inattention

AND EITHER

3. Disorganized thinking

OR

4. Altered level of consciousness

Adapted from these sources:

Inouye SK, van Dyck CH, Lessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method of detection of delirium. Ann Intern Med. 1990; 113(12): 941-948.

For a the Confusion Assessment Method (CAM) Diagnostic Algorithm, or to download a printable copy of the CAM, click here.

Currently serving Omaha and surrounding areas, all Encompass services are directed by registered nurses or licensed clinical social workers with no long-term contracts. Contact us today for help with your senior care needs.

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“Encompass Senior Solutions solves the challenges families face in caring for aging parents, with a focus on strategies that keep them in their homes. To learn more about our solutions, visit http://www.encompass-assessments.com.”