There is an interesting paper on Delirium from 2013 by Davis et al titled ‘The Epidemiology of Delirium: Challenges and Opportunities for Population Studies’. In the first section of the paper the authors look at the problems faced in epidemiological research. The issues here are particularly relevant to epidemiological researchers but also hold some interest in the interpretation of epidemiological studies or meta-analyses/systematic reviews. A key point in the discussion looked at how results were interpreted – were subjects with complete data included only (with associated bias) or was there an attempt to anticipate data for missing subjects (e.g using random effects modelling).
What I found quite interesting about the paper is the later section which reviews some of the epidemiological studies. The Gerontological Database research study revealed some very useful data about prevalence in people over the age of 85. Age was strongly linked to the prevalence of Delirium in this study which used DSM-IV criteria. The prevalence of Delirium in the 85-89 year age group was 19% compared to 39% in the 95+ age group. The only drawback was that the confidence interval data was missing and it wasn’t clear if this was point or 1-month period prevalence as reported for other data from the study. Regardless, the original study would merit further attention as if this pattern is replicated there is likely to be an important biological link (e.g blood-brain barrier integrity etc) that could be further investigated. The other point is whether there is comorbid Dementia. Nevertheless this does not escape the fact that there is Delirium regardless of whether it is a comorbidity.
The final section looks at the issue of improving epidemiological studies and the methodology here has some overlap with approaches with the potential to improve clinical practice.
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