How do predisposing factors differ between delirium motor subtypes? A systematic review and meta-analysis

Abstract

Background: Delirium is a common neurocognitive disorder in hospitalised older adults with vast negative consequences. The predominant method of subtyping delirium is by motor activity profile into hypoactive, hyperactive and mixed groups.

Objective: This systematic review and meta-analysis investigated how predisposing factors differ between delirium motor subtypes.

Methods: Databases (Medline, PsycINFO, Embase) were systematically searched for studies reporting predisposing factors (prior to delirium) for delirium motor subtypes. A total of 61 studies met inclusion criteria (N = 14,407, mean age 73.63 years). Random-effects meta-analyses synthesised differences between delirium motor subtypes relative to 22 factors.

Results: Hypoactive cases were older, had poorer cognition and higher physical risk scores than hyperactive cases and were more likely to be women, living in care homes, taking more medications, with worse functional performance and history of cerebrovascular disease than all remaining subtypes. Hyperactive cases were younger than hypoactive and mixed subtypes and were more likely to be men, with better cognition and lower physical risk scores than all other subtypes. Those with no motor subtype (unable to be classified) were more likely to be women and have better functional performance. Effect sizes were small.

Conclusions: Important differences in those who develop motor subtypes of delirium were shown prior to delirium occurrence. We provide robust quantitative evidence for a common clinical assumption that indices of frailty (institutional living, cognitive and functional impairment) are seen more in hypoactive patients. Motor subtypes should be measured across delirium research. Motor subtyping has great potential to improve the clinical risk assessment and management of delirium.

Keywords: hyperactive; hypoactive; mixed; older people; risk factor; systematic review.

Figure 1

Effect sizes (Hedges’ g) for random-effects meta-analyses conducted on differences between motor subtypes of delirium on continuous predisposing factors. Positive Hedges’ g indicates higher scores on factor in Group A compared with Group B. X = non-significant result (P > 0.05), − = analysis unable to be conducted (insufficient data).

Figure 2

Effect sizes (odds ratio) for random-effects meta-analyses conducted on differences between motor subtypes of delirium on categorical predisposing factors. OR > 1 indicates greater likelihood of the factor being present in Group A compared with Group B. X = non-significant result (P > 0.05), − = analysis unable to be conducted (insufficient data).

Figure 3

Percentage of studies with high risk (black), low risk (white) or unclear (grey) risk of bias ratings for each Risk of Bias for Non-randomised Studies (RoBANS) item assessed by authors.