Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients

Background: In an ever-aging society, health care systems will be confronted with an increasing number of patients over 80 years (“the very old”). Currently, knowledge about and recommendations for delirium management are often based on studies in patients aged 60 to 65 years. It is not clear whether these findings apply to patients ≥80 years.Aim: Comparison of younger and older patients with delirium, especially regarding risk factors.Methods: In this prospective cohort study, within 1-year, 5,831 patients (18–80 years: n = 4,730; ≥80: n = 1,101) with delirium were enrolled. The diagnosis of delirium was based on the Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5 construct of nursing instrument. Sociodemographic trajectories, as well as the relevant predisposing and precipitating factors for delirium, were assessed via a multiple regression analysis.Results: The very old were more commonly admitted as emergencies (OR 1.42), had a greater mortality risk (OR 1.56) and displayed fewer precipitating risk factors for the development of a delirium, although the number of diagnoses were not different (p = 0.325). Predisposing factors were sufficient almost alone for the development of delirium in patients ≥ 80 years of age; in 18–80 years of age, additional precipitating factors had to occur to make a delirium possible.Conclusion: When relevant predisposing factors for delirium are apparent, patients over 80 years of age require comparatively few or no precipitating factors to develop delirium. This finding should be taken into account at hospitalization and may allow better treatment of delirium in the future.

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Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2019-035809 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035809

Author(s):

Bert Vaes ◽

Paulien Indestege ◽

Tinne Serneels ◽

Eralda Hegendörfer ◽

Petra G van Peet ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort Study ◽

Predictive Value ◽

Prospective Cohort ◽

Risk Models ◽

Very Old ◽

Old Adults ◽

History Of ◽

Traditional Risk Factors

ObjectivesTo test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers.DesignCross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study.SettingGeneral practice, Belgium and The Netherlands.ParticipantsThe BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD.Outcome measuresThe model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models.ResultsTraditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI −0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)).ConclusionsThis study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.

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The Natural Course and Risk Factors for Progression of Diabetic Retinopathy-KNDP Prospective Cohort Study

Diabetes ◽

10.2337/db18-1571-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1571-P

Author(s):

HYUN UK MOON ◽

JA YOUNG JEON ◽

SOOJIN LEE ◽

SEUNG JIN HAN ◽

HAE JIN KIM ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Natural Course

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Faculty Opinions recommendation of Travel to Asia and traveller's diarrhoea with antibiotic treatment are independent risk factors for acquiring ciprofloxacin-resistant and extended spectrum β-lactamase-producing Enterobacteriaceae-a prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726379311.793526620 ◽

2016 ◽

Author(s):

José Luis Martínez

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Antibiotic Treatment ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Extended Spectrum ◽

Independent Risk Factors ◽

Traveller’S Diarrhoea

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Primary and Recurrent Breast Abscess in Non Lactational Women, Assessment of Risk Factors and Bacteria Involved. A prospective Cohort Study for Patients and Healthy Control

International Journal of Psychosocial Rehabilitation ◽

10.37200/ijpr/v24i5/pr2020597 ◽

2020 ◽

Vol 24 (5) ◽

pp. 6191-6198

Author(s):

Israa Abdul Wahed Dheeb

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Breast Abscess ◽

Healthy Control ◽

Recurrent Breast

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Prenatal Sociodemographic Factors Predicting Maltreatment of Children up to 3 Years Old: A Prospective Cohort Study Using Administrative Data in Japan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052505 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2505

Author(s):

Aya Isumi ◽

Kunihiko Takahashi ◽

Takeo Fujiwara

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Child Maltreatment ◽

Survey Data ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Risk Scores ◽

Prenatal Risk ◽

Prenatal Risk Factors

Identifying risk factors from pregnancy is essential for preventing child maltreatment. However, few studies have explored prenatal risk factors assessed at pregnancy registration. This study aimed to identify prenatal risk factors for child maltreatment during the first three years of life using population-level survey data from pregnancy notification forms. This prospective cohort study targeted all mothers and their infants enrolled for a 3- to 4-month-old health check between October 2013 and February 2014 in five municipalities in Aichi Prefecture, Japan, and followed them until the child turned 3 years old. Administrative records of registration with Regional Councils for Children Requiring Care (RCCRC), which is suggestive of child maltreatment cases, were linked with survey data from pregnancy notification forms registered at municipalities (n = 893). Exact logistic regression was used for analysis. A total of 11 children (1.2%) were registered with RCCRC by 3 years of age. Unmarried marital status, history of artificial abortion, and smoking during pregnancy were significantly associated with child maltreatment. Prenatal risk scores calculated as the sum of these prenatal risk factors, ranging from 0 to 7, showed high predictive power (area under receiver operating characteristic curve 0.805; 95% confidence interval (CI), 0.660–0.950) at a cut-off score of 2 (sensitivity = 72.7%, specificity = 83.2%). These findings suggest that variables from pregnancy notification forms may be predictors of the risk for child maltreatment by the age of three.

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Inter-observer reliability of a risk assessment model for venous thromboembolism in acutely-ill medical hospitalized patients: Results from a prospective cohort study

Phlebology The Journal of Venous Disease ◽

10.1177/02683555211021226 ◽

2021 ◽

pp. 026835552110212

Author(s):

Cassia RL Ferreira ◽

Marcos de Bastos ◽

Mirella L Diniz ◽

Renan A Mancini ◽

Yan S Raposo ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Venous Thromboembolism ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Risk Classification ◽

Assessment Model ◽

Kappa Statistics ◽

Medical Patients ◽

Observer Reliability

Objectives To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. Methods In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. Results We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for “immobilization”, to almost perfect (0.98; 95% CI 0.97-0.99) for “thrombophilia”; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Conclusion Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.

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