Exploration of Relationships Between Postoperative Pain and Subsyndromal Delirium in Older Adults

Denny, Dawn L.; Such, Tami L

doi:10.1097/nnr.0000000000000305

Cited by 25 publications

(14 citation statements)

References 33 publications

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“…In previous studies these factors were associated with delirium: functional impairment (3,26,34) pain (26,35), low hemoglobin or hematocrit level (26,34,36), hyponatremia (37,38), and hypocalcemia (32,39). In studies of risk factors for SSD an association was found with some of the same factors that were significantly associated with it in the present study in univariate analyses, including functional impairment (7,18), pain (40), and hyponatremia (18).…”

Section: Risk Factors For Deliriumsupporting

confidence: 74%

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

et al. 2020

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Background: The aim of the study was to assess the occurrence rate of delirium among elderly hospitalized patients in the medicine wards of a large tertiary hospital, to identify risk factors, and to evaluate the diagnostic rate for delirium among the medical teams. Methods: A 3-month prospective study of patients 65 years of age and above in three medicine wards: in two wards patients were examined by trained study team members using the Confusion Assessment Method (CAM), while the third was a control ward where CAM was not administered. The third ward served to control for the effect of the presence of investigators in the other wards as a potential confounding factor. Based on the results of this assessment patients were defined as suffering from subsyndromal delirium, full delirium (these two groups were later combined into an "any symptoms of delirium" group), and no delirium. The rate of diagnosis by the medical team was obtained from the electronic medical records. Results: The full delirium rate was 5.1%, the rate of subsyndromal delirium was 14.6%, and the rate of any symptoms of delirium was 19.6%. Absence of a partner, pain, anemia, hyponatremia, hypocalcemia, and the use of drugs with an anticholinergic burden were factors for any symptoms of delirium as well as for subsyndromal delirium. Subsyndromal delirium and any symptoms of delirium were associated with a reduced chance of being discharged to home and a higher 3-month mortality rate. A diagnosis of delirium was found in only 19.4% of the patients with any symptoms of delirium in the medical records. Conclusions: Delirium is a common problem among elderly hospitalized patients, but it is diagnosed sub-optimally by the medical team. There is a need for further training of the medical teams and implementation of delirium assessment as part of the ward's routine.

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Section: Risk Factors For Deliriumsupporting

confidence: 74%

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

et al. 2020

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“…A recent study found that BIS-guided deep anesthesia reduced early postoperative cognitive decline and inhibited postoperative peripheral inflammation in elderly patients [ 46 ]. A third limitation involves pain severity, which is a known factor associated with PD [ 47 ]. The quality and the type of analgesia were not taken into account in our study because all patients were given sufentanil 0.1 μg/kg at about 30 min before the end of the surgery, patient-controlled intravenous or epidural analgesia, and additional analgesics as needed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bispectral Index-Guided Individualized Anesthesia with Standard General Anesthesia on Inadequate Emergence and Postoperative Delirium in Elderly Patients Undergoing Esophagectomy: A Retrospective Study at a Single Center

Yang

Song

et al. 2020

Med Sci Monit

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“…In this study, nearly seven of 10 participants developing subsyndromal delirium (68%, n = 36), whereas 17% ( n = 9) developed delirium. In studies examining subsyndromal delirium in older adults, incidence rates vary between studies from 27% to 69% in hospitalized older adults following noncardiac surgery (Denny & Such, 2018; Liptzin et al, 2005; Shim et al, 2015). However, the sample sizes of these previous studies varied widely from 49 to 615.…”

Section: Discussionmentioning

confidence: 99%

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

Denny

Lindseth

2019

West J Nurs Res

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This study examined the effects of pain and opioid intakes on subsyndromal delirium in older adults who had joint replacement surgery. Delirium assessments of 53 older adults were completed on the first, second, and third days following joint replacement surgery using the Confusion Assessment Method (CAM). Statistical relationships were analyzed using correlations and multiple regressions. Subsyndromal delirium developed in 68% ( n = 36) of participants. Pain was significantly related ( p < .05) to increased delirium symptoms after accounting for preoperative risk factors of comorbidity, cognitive status, fall history, and preoperative fasting times, whereas opioid intake was not significantly associated with increased delirium symptoms. Findings suggest older adults with increased pain levels are at higher risk for subsyndromal delirium as well as delirium after joint replacement surgery.

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Exploration of Relationships Between Postoperative Pain and Subsyndromal Delirium in Older Adults

Cited by 25 publications

References 33 publications

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

Delirium in Internal Medicine Departments in a Tertiary Hospital in Israel: Occurrence, Detection Rates, Risk Factors, and Outcomes

Comparison of Bispectral Index-Guided Individualized Anesthesia with Standard General Anesthesia on Inadequate Emergence and Postoperative Delirium in Elderly Patients Undergoing Esophagectomy: A Retrospective Study at a Single Center

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

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