New Study Finds Family and Caregivers Can Help Spot Post-Surgery Delirium Early

A new study published in the Journal of Clinical Anesthesia shows that family members and caregivers can play a critical role in detecting delirium after surgery using a simple tool known as the Family Confusion Assessment Method. Because delirium can slow the healing and recovery process and requires immediate treatment, the findings suggest that involving families in monitoring could lead to faster recognition, earlier treatment, and better outcomes for older patients.

FAM-CAM is a screening tool completed by family members and caregivers to help clinicians determine whether changes in a patient’s thinking, concentration, and alertness are the result of delirium. It was created in 1990 by Sharon K. Inouye, MD, MPH, senior scientist and Milton and Shirley F. Levy Family Chair at the Hinda and Marcus Institute for Aging Research.

The study, “Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM),” published in the Journal of Clinical Anesthesia, followed 817 older adults undergoing major elective surgery and collected 1,349 paired delirium assessments from both trained researchers and family caregivers.

Researchers’ assessments found postoperative delirium in 18.8% of patients, while families using FAM-CAM identified symptoms in 22.4% of cases. There was nearly 80% agreement between researcher and family ratings, with strong statistical reliability.

The study also extended into the recovery period at home. Families were given FAM-CAM booklets to use for 30 days after surgery. Of the 133 families who returned the forms, 18 patients showed signs of delirium after discharge. Importantly, half of these cases had not been diagnosed in the hospital. This indicates that FAM-CAM could help catch symptoms that otherwise go unnoticed once patients leave the hospital.

Why it matters

Delirium — an acute state of confusion that affects thinking, attention, and awareness — is one of the most common complications after surgery in older adults, yet it is frequently missed or misdiagnosed. Other studies suggest delirium goes undetected in 30-60% of cases in hospitals. However, even short episodes can have lasting consequences, including longer hospital stays, increased risk of falls, higher rates of institutionalization, and, in some cases, accelerated cognitive decline or dementia.

Part of the challenge is that delirium symptoms can fluctuate, appearing one moment and disappearing the next. Busy clinical teams may not always be present to catch the changes. Families, who often know their loved one’s “normal” baseline, may be better positioned to notice subtle shifts in alertness, memory, or behavior — if given the right tools.

“Our study shows that family members, with minimal training, can serve as effective partners in detecting postoperative delirium — not just in the hospital but also during the crucial recovery period at home. This opens the door to more responsive, continuous care that could reduce harms from delayed diagnosis and improve outcomes for older surgical patients,” said Inouye.

In addition to Inouye, the other researchers include: Angela M. Mickle, MS; Bethany R. Tellor Pennington, PharmD; Arbi Ben Abdallah, PhD; Jordan Oberhaus, BS; Thaddeus P. Budelier, BS; Daniel Park, BS; Michael S. Avidan, MBBCh; and Ben J. Palanca, MD, PhD, Department of Anesthesiology, Washington University School of Medicine; Wei Wang, PhD; and Nan Lin, PhD, Department of Statistics and Data Science, Washington University; Troy S. Wildes, MD, Department of Anesthesiology, University of Nebraska Medical Center; and Eva M. Schmitt, PhD, assistant scientist, Hinda and Arthur Marcus Institute for Aging Research.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across seven campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $98 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, Threads, and LinkedIn.