Feature 1—altered mental status or fluctuating course—is obtained from a collateral historian (eg, family member, caregiver) who knows the patient’s baseline cognition. Because ~40% of older ED patients may not have a family member or caregiver available in the ED, they may need to be contacted by phone. Fluctuations in mental status can also be observed during the patient’s evaluation.
Feature 2—inattention. Patients who are inattentive are easily distractible to irrelevant stimuli and can have difficulty maintaining a conversation. Inattentive patients may also fall asleep during the interview, especially when disengaged. Questions often have to be repeated because the patient is inattentive.
Feature 3—disorganized thinking. Patients with disorganized thinking exhibit incoherent thought processes. They may ramble, have irrelevant conversations, or have inappropriate responses to questions. They may also exhibit illogical tangential thoughts, circumstantiality, or illogical flow of ideas.
Feature 4—altered level of consciousness—is a patient who is drowsy, lethargic, anxious, restless, or agitated.
Inouye SK. 2003; Boston, MA: Hospital Elder Life Program hospitalelderlifeprogram.org/uploads/disclaimers/CAM_Training_Manual_(Long_CAM)_9-23-14.pdf. Accessed May 7, 2019. Last update September 8, 2014
Inouye SK, et al. Ann Intern Med. 1990;113(12):941–948
CAM, Confusion Assessment Method
ED, emergency department