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.

Knowledge, attitude, and practice toward delirium and subtype assessment among Chinese clinical nurses and determinant factors: A multicentre cross-section study

“…The barriers to assessment and practice, the influencing factors, and details in practice progress also need to be considered. Previous studies have shown that there are significant differences in the predisposing factors, etiology, treatment and outcomes among each subtype ( 56 – 58 ). It is necessary to clarify nurses' KAP status in subtype assessment to make subtype management protocols in the future.…”

Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium

“…Those that developed hyperactive delirium were more likely to be younger, male, and have higher cognitive scores. 31 However, that review included studies that varied considerably in the reasons patients were hospitalized, including cancer, cardiac surgery, stroke, palliative care, urgent and elective surgeries, etc. In addition, prior studies used different methods for assessing delirium including the Richmond Agitation Sedation Scale and the Delirium Motor Subtype Scale which focus on symptoms of agitation and level of consciousness.…”

“…They found that patients who had hypoactive delirium were older, had poorer cognitive functioning, and higher risks scores than those with hyperactive delirium. Those that developed hyperactive delirium were more likely to be younger, male, and have higher cognitive scores 31 . However, that review included studies that varied considerably in the reasons patients were hospitalized, including cancer, cardiac surgery, stroke, palliative care, urgent and elective surgeries, etc.…”

Does the Etiology, Phenomenology and Motor Subtype of Delirium Differ When It Occurs in Patients With An Underlying Dementia?: A Multi-Site, International Study

“…Many recent studies have looked to break delirium down into motor subtypes as a way of facilitating more accurate diagnosis and management. 18 , 19 Hypoactive delirium has been associated with older age, increased medication exposure, increased risk of being missed or misdiagnosed and a greater risk of morbidity and mortality, while hyperactive delirium has been linked to younger patients and carries a better prognosis. 18 It is therefore important to establish whether motor subtype differ in those with an underlying dementia, as this is a vulnerable group where delirium assessment and management can prove particularly challenging.…”