Dawn L. Denny

Date of Award

January 2014

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Glenda Lindseth

Abstract

Study Purpose and Design: The purpose of this study was to determine the relationship between subsyndromal delirium and pain in older adults following major elective orthopedic surgery. The design of this correlational study was based on Inouye and Charpentier's (1996) multifactorial model of delirium.

Methods: Delirium assessments of 62 older adults were completed at 24, 48, and 72 hours following major elective orthopedic surgery. Study measures included: a) the Iowa Pain Thermometer (0-10) pain intensity scale; and b) the Confusion Assessment Method (short form). Data were analyzed for relationships among delirium symptoms and pain, and secondarily, 24-hour opioid intake controlling for preoperative risk factors.

Findings: Subsyndromal delirium occurred in 67.9 percent of participants in this study. Increased pain from 0 to 24 hours after surgery had a significant (p<.05) relationship with subsyndromal delirium on the second postoperative day. Similarly, increased pain from 24 to 48 hours had a significant (p<.05) relationship with delirium symptoms on the second postoperative day. Opioid intake was not significantly related to subsyndromal delirium.

Conclusions and Implications for Clinical Practice: Findings from this study suggest older adults with higher levels of pain are at higher risk for developing delirium symptoms and subsyndromal delirium on the second day following major elective orthopedic surgery. Improved pain management may help reduce subsyndromal delirium when attention is given to pain on the second postoperative day.

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