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

Denny, Dawn L.; Such, Tami L.

doi: 10.1097/NNR.0000000000000305
ORIGINAL ARTICLES

Background Subsyndromal delirium is associated with serious adverse outcomes of longer lengths of stay, increased long-term care admissions, and higher 6-month mortality rates. Postoperative pain is a risk factor for delirium, but the relationship between pain and the severity of subclinical delirium symptoms is unclear. A better understanding will inform nursing interventions to reduce adverse outcomes associated with delirium symptoms.

Objectives The purpose of this correlational study was to determine the relationship between pain and subsyndromal delirium in older adults following joint replacement surgery.

Methods Delirium assessments were completed on postoperative Days 1, 2, and 3 for 49 adults of ages 65 years or older following joint replacement surgery. Multiple linear regression was used to analyze data for relationships between postoperative pain and subsyndromal delirium and, secondarily, postoperative opioid intake and subsyndromal delirium while accounting for known preoperative risk factors.

Results Increased age, cognitive impairment, current smoking, and higher levels of self-reported pain were significantly related to subsyndromal delirium (p < .001). After accounting for preoperative risk factors of age, cognitive status, smoking status, and opioid intake, pain was significantly related to subsyndromal delirium (β = .28, p < .05); however, opioid intake did not contribute to subsyndromal delirium.

Discussion Higher pain levels were significantly related to subsyndromal delirium when age, cognitive status, smoking status, and opioid intake were accounted for (p < .05), although opioid intake was not significantly related to subsyndromal delirium after accounting for age, cognitive status, smoking status, and pain. Nurses caring for older adults who undergo joint replacement surgery are encouraged to ensure effective pain management to reduce onset and severity of delirium symptoms.

Dawn L. Denny, PhD, ONC, RN, is Assistant Professor, University of North Dakota College of Nursing and Professional Disciplines, Grand Forks.

Tami Such, MSN, RN, PHN, is PhD Nursing Student, University of North Dakota College of Nursing and Professional Disciplines, Grand Forks, and Chair and Associate Professor for the Division of Nursing, Mayville State University, North Dakota.

Accepted for publication April 20, 2018.

The authors acknowledge the research reported in this publication was supported by funding provided by the College of Nursing and Professional Disciplines and the Senate Scholarly Activities Committee at the University of North Dakota, Grand Forks, ND.

This study was approved by the institutional review board at the University of North Dakota and Altru Health System in Grand Forks, ND.

The authors have no conflicts of interest to report.

Corresponding author: Dawn L. Denny, PhD, ONC, RN, University of North Dakota College of Nursing and Professional Disciplines, 430 Oxford Street, Stop 9025, Grand Forks, ND 58202 (e-mail: dawn.denny@und.edu).

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