Hyperactive and hypoactive psychomotor subtypes of delirium in demented and nondemented elderly patients with hip fractures: Systematic review and meta-analysis

Abstract

Background: The occurrence of delirium superimposed on dementia (DSD) in patients with hip fracture may have many life-threatening complications, especially if unrecognized and untreated. Objectives: To estimate the prevalence and outcomes of DSD in hospitalized elderly adults with dementia and hip fracture, and clinical symptoms of delirium with and without dementia. Methods: The review process followed guidelines consisting of 5 steps suggested for systematic reviews. Relevant studies between January 2000 to December 2014 were obtained from electronic databases, and 2 trained reviewers independently analyzed them. Comprehensive Meta-Analysis software (Biostat) was used to assess and combine the data across studies. Results: We identified 15 articles for meta-analysis. Prevalence of DSD after hip fracture was 69.7% (95% confidence interval [CI] = 60.4%-77.7%). People with dementia after hip fracture had a 6.03 times higher likelihood of sustaining delirium than those without dementia (95% CI = 3.63%-10.04%). The symptoms of delirium in a person without dementia was more often any hyperactivity (ES = 2.27, 95% CI = 1.17-4.41, P = 0.015), but those lacking dementia were more often hypoactive (ES = 2.22, 95% CI = 1.15-4.56, P = 0.018). There was limited evidence of publication bias, and there was substantial selective reporting bias in articles. Conclusions: The review demonstrates the high prevalence of DSD and highlights the differences in motor subtypes of delirium between delirium with and without dementia, but there is concern about these results given the high risk of bias.