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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.

Hip fracture commonly occurs in adult patients over 65 years old at a prevalence rate that is estimated to be 756 per 100 thousand cases. Thus, hip fracture surgery is one of the most common emergency operations in older adult populations. In addition, the incidence rate in older adults of post-operative delirium, which leads to symptoms of disturbance related to cognition, attention, perception, logic, memory, psychological activities, mood, and sleep, has been reported as 5%-61%. The many possible complications of post-operative delirium, including death, increase medical costs and family burdens if not managed properly. Proper management involves healthcare providers initiating early assessments, reducing accelerated factors, and providing appropriate care. As diagnosing and differentiating post-operative delirium in clinical practice is difficult, this condition is easily neglected by healthcare teams, resulting in adequate care not being provided to this population. The aim of this paper was to review th