Evaluating Pain, Opioids, and Delirium in Critically Ill Older Adults

Clin Nurs Res. 2021 May;30(4):455-463. doi: 10.1177/1054773820973123. Epub 2020 Nov 20.


Untreated pain and pain management with opioids are independent precipitating factors for delirium. This retrospective study evaluated the relationships among pain severity, its management with opioids, and the onset of delirium in older adult patients admitted to the surgical intensive care unit (SICU). Consecutive patients aged 65 or greater admitted to the SICU over a 5-month period were examined (n = 172). When assessed using a multivariable general estimating equation model, opioids (chi-square [χ2], 12.34, p = .0004), but not pain (χ2, 3.31, p = .0688) were significant in predicting next-day delirium status. Controlling for pain, patients exposed to opioids were 2.5 times more likely to develop delirium than patients not exposed (95% Confidence Interval: 1.44-4.36). Our data shows that opioid administration predicted the onset of next-day delirium. In an effort to prevent delirium, future research should focus on opioid-sparing pain management approaches to mitigate pain and delirium.

Keywords: SICU; critical care; delirium; elderly; older adult; opioid; pain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analgesics, Opioid* / adverse effects
  • Critical Illness
  • Delirium*
  • Humans
  • Intensive Care Units
  • Pain / drug therapy
  • Prospective Studies
  • Retrospective Studies


  • Analgesics, Opioid