Interactions between pain and delirium are complex and multidirectional. Pain and delirium often occur together especially in older populations and those with dementia. In general, medical and geriatric hospital units’ delirium is found in 29–64% of inpatients. Here, 8–17% of all older people and 40% of those residing in residential care have delirium. The prevalence of delirium in the community is low, but a delirium prevalence of 36.8% has been reported in residential aged care settings and the onset of delirium often precipitates presentation to the emergency department. Chronic pain rates are reported to be even higher. Pain affects 20–46% of older people living in the community, and 28–73% of those living in residential care. The complex interplay between dementia, pain and delirium warrants further investigation across a range of settings.īoth pain and delirium are common problems for older people across a range of clinical and residential settings. Guidelines for people with pain and dementia require adaptations regarding the unique characteristics of delirium. Tentative recommendations, drawing on current guidelines require robust testing. The current evidence base regarding assessing pain in people with delirium is lacking. Evidence concerning the reliability and validity of current observational and self-assessment tools in people with delirium is unclear but some show promise in this population. The fluctuating nature of delirium as well as reduced awareness and attention may challenge practitioners in recognizing, assessing and treating pain. Delirium affects the ability to self-report pain. Factors acting on the pathway between pain and delirium may include depression, sleep deprivation and disturbance of the cholinergic system. ResultsĪ limited number of studies suggest there is an association between pain and delirium however, this is a complex, particularly where analgesics which may-themselves cause delirium are prescribed. This paper aims to explore the complex relationship between pain and delirium and on pain assessment in delirium, drawing together evidence from a range of settings including acute medical, cardiac and orthopaedic post-operative cohorts, as well as from aged care. This can make it challenging for staff to recognize and treat pain in people with delirium. Pain and delirium are known to interact in a complex and multidirectional way. In people living in the community, delirium often precipitates presentation to the emergency department. Both conditions are prevalent in acute hospital settings. Pain and delirium are common problems for older people.
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