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      Prevalence and risk factors of delirium in psychogeriatric outpatients

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          Abstract

          Background

          Delirium is a serious neuropsychiatric syndrome, which requires timely treatment. However, it is easily missed, especially in older patients with premorbid cognitive disorders.

          Objectives

          The aim of this study is to investigate the prevalence and risk factors of delirium in older outpatients with and without dementia.

          Method

          We assessed 444 patients referred to the memory clinic of a psychiatric hospital between March 2013 and March 2014. Demographic information, medical history, impairments in daily living activities and referral information were registered. Patients underwent a psychiatric examination using the Delirium Rating Scale‐Revised‐98 and cognitive tests, a physical examination and laboratory tests. We recorded medication use and changes before and after the onset of symptoms.

          Results

          Among the 444 outpatients, 85 had probable delirium (prevalence of 19%), and 10 had subsyndromal delirium (2%). The most common triggers were infection (42%), drug‐intoxication or withdrawal (22%), and metabolic/endocrine disturbance (12%). Age (OR 1.07, 95% CI 1.02‐1.11) and prior delirium (OR 3.34, 95% CI 1.28‐8.69) were independent non‐modifiable factors associated with an increased risk of delirium. The only independent modifiable risk factor was infection (OR 17.31, 95% CI 8.44‐35.49).

          Conclusions

          A delirium was detected in one of five patients referred for dementia screening. Most patients could be treated at home. Age and prior delirium were predictive of an increased risk of delirium.

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          Most cited references25

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis.

            Delirium is a common and serious complication in elderly patients. Evidence suggests that delirium is associated with long-term poor outcome but delirium often occurs in individuals with more severe underlying disease. To assess the association between delirium in elderly patients and long-term poor outcome, defined as mortality, institutionalization, or dementia, while controlling for important confounders. A systematic search of studies published between January 1981 and April 2010 was conducted using the databases of MEDLINE, EMBASE, PsycINFO, and CINAHL. Observational studies of elderly patients with delirium as a study variable and data on mortality, institutionalization, or dementia after a minimum follow-up of 3 months, and published in the English or Dutch language. Titles, abstracts, and articles were reviewed independently by 2 of the authors. Of 2939 references in the original search, 51 relevant articles were identified. Information on study design, characteristics of the study population, and outcome were extracted. Quality of studies was assessed based on elements of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. The primary analyses included only high-quality studies with statistical control for age, sex, comorbid illness or illness severity, and baseline dementia. Pooled-effect estimates were calculated with random-effects models. The primary analysis with adjusted hazard ratios (HRs) showed that delirium is associated with an increased risk of death compared with controls after an average follow-up of 22.7 months (7 studies; 271/714 patients [38.0%] with delirium, 616/2243 controls [27.5%]; HR, 1.95 [95% confidence interval {CI}, 1.51-2.52]; I(2), 44.0%). Moreover, patients who had experienced delirium were also at increased risk of institutionalization (7 studies; average follow-up, 14.6 months; 176/527 patients [33.4%] with delirium and 219/2052 controls [10.7%]; odds ratio [OR], 2.41 [95% CI, 1.77-3.29]; I(2), 0%) and dementia (2 studies; average follow-up, 4.1 years; 35/56 patients [62.5%] with delirium and 15/185 controls [8.1%]; OR, 12.52 [95% CI, 1.86-84.21]; I(2), 52.4%). The sensitivity, trim-and-fill, and secondary analyses with unadjusted high-quality risk estimates stratified according to the study characteristics confirmed the robustness of these results. This meta-analysis provides evidence that delirium in elderly patients is associated with poor outcome independent of important confounders, such as age, sex, comorbid illness or illness severity, and baseline dementia.
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              What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models.

              Statistical models, such as linear or logistic regression or survival analysis, are frequently used as a means to answer scientific questions in psychosomatic research. Many who use these techniques, however, apparently fail to appreciate fully the problem of overfitting, ie, capitalizing on the idiosyncrasies of the sample at hand. Overfitted models will fail to replicate in future samples, thus creating considerable uncertainty about the scientific merit of the finding. The present article is a nontechnical discussion of the concept of overfitting and is intended to be accessible to readers with varying levels of statistical expertise. The notion of overfitting is presented in terms of asking too much from the available data. Given a certain number of observations in a data set, there is an upper limit to the complexity of the model that can be derived with any acceptable degree of uncertainty. Complexity arises as a function of the number of degrees of freedom expended (the number of predictors including complex terms such as interactions and nonlinear terms) against the same data set during any stage of the data analysis. Theoretical and empirical evidence--with a special focus on the results of computer simulation studies--is presented to demonstrate the practical consequences of overfitting with respect to scientific inference. Three common practices--automated variable selection, pretesting of candidate predictors, and dichotomization of continuous variables--are shown to pose a considerable risk for spurious findings in models. The dilemma between overfitting and exploring candidate confounders is also discussed. Alternative means of guarding against overfitting are discussed, including variable aggregation and the fixing of coefficients a priori. Techniques that account and correct for complexity, including shrinkage and penalization, also are introduced.
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                Author and article information

                Contributors
                h.j.luijendijk@umcg.nl
                Journal
                Int J Geriatr Psychiatry
                Int J Geriatr Psychiatry
                10.1002/(ISSN)1099-1166
                GPS
                International Journal of Geriatric Psychiatry
                John Wiley & Sons, Inc. (Chichester, UK )
                0885-6230
                1099-1166
                02 September 2020
                January 2021
                : 36
                : 1 ( doiID: 10.1002/gps.v36.1 )
                : 190-196
                Affiliations
                [ 1 ] University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine Groningen The Netherlands
                [ 2 ] Parnassia Groep/ Bavo Europoort, Department of Elderly Psychiatry Rotterdam The Netherlands
                Author notes
                [*] [* ] Correspondence

                Hendrika J. Luijendijk, Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, PO Box 196, Groningen 9700 AD, The Netherlands.

                Email: h.j.luijendijk@ 123456umcg.nl

                Author information
                https://orcid.org/0000-0003-2932-6461
                Article
                GPS5413
                10.1002/gps.5413
                7754178
                32844507
                25437541-4249-4124-9863-1c3fd3ecdd89
                © 2020 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 May 2019
                : 19 June 2020
                : 08 August 2020
                Page count
                Figures: 1, Tables: 2, Pages: 7, Words: 5015
                Funding
                Funded by: Parnassia Groep Stimuleringsfonds
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                January 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:22.12.2020

                Geriatric medicine
                delirium,elderly,older patient,prevalence,risk factors
                Geriatric medicine
                delirium, elderly, older patient, prevalence, risk factors

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