THE ROLE OF PAIN MANAGEMENT AMONG HOSPITALIZED OLDER ADULTS WITH DELIRIUM

Inadequate treatment of pain is a known risk factor for delirium among older adults. However, little is known about pain management among hospitalized older adults with delirium. We sought to investigate the role of pain and pain management in the development of delirium among older adults with moderate to severe pain admitted to the medicine service. Medical record review was conducted on adults ≥ 65 years admitted to the medicine service at an urban hospital between November 2014 and May 2015 with moderate to severe pain defined by the Numerical Pain Rating Scale score: 4 – 10. Of 254 patients with moderate to severe pain on admission, 41 (16%) were diagnosed with delirium during their hospitalization. Compared to patients without delirium, those with delirium were more likely to be age ≥ 75 years (59% vs. 42%, p=0.05), have a history of dementia (29% vs. 7%, p<0.0001), experience longer length of hospitalization (8 days vs. 5 days, p=0.03), and receive a palliative care consult (32% vs. 10%, p=0.0002). During hospitalization, patients received opioids (76%), acetaminophen (68%), adjuvant analgesics (34%), and nonsteroidal anti-inflammatory drugs (5%). There was no difference in pain severity or frequency of analgesic administration in patients with and without delirium. However, prior to admission, patients with delirium were more likely to be prescribed adjuvant analgesics (39% vs. 22%, p=0.02). In conclusion, pain management among hospitalized older adults was similar for those with and without delirium. Further research is needed to understand the role of adjuvant analgesics in older adults with delirium.