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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.

The aim of this review was to explore the extent and nature of evidence exploring shiftwork and disruptions to cortisol. A systematic search was conducted across five databases: Medline, EMBASE, Psych INFO, Joanna Briggs Institute and PubMed between July-August 2020. Cortisol data were characterised into three main outcomes, 1) cortisol levels, 2) cortisol rhythm, and 3) cortisol awakening response (CAR) during shiftwork. Main findings demonstrate that shiftwork, especially night shift, significantly disrupts production of cortisol, the cortisol rhythm and CAR and, irregular shift schedules produce greater disruptions to cortisol than regular shift schedules. It was difficult to draw conclusions about the impact of shiftwork on movement of the cortisol rhythm and adaptation or recovery of the cortisol rhythm to and from night shift as the literature lacks consistency in definition of methods and variables. The present state of literature demonstrates cortisol levels, cortisol rhythm and the CAR are all disrupted by shiftwork, but there is a lack of consistency between studies on use of variables and most of the literature focuses on acute disruption rather than chronic effects. It will be important for future studies to investigate possible mechanisms that link shiftwork, disruptions to cortisol and chronic health conditions prevalent in shiftworkers. Refereed/Peer-reviewed