Objective Delirium and pain are common in older adults admitted to hospital. The relationship between these is unclear, but clinically important. We aimed to systematically review the association between pain (at rest, movement, pain severity) and delirium in this population. Methods PubMed, EMBASE, CINAHL, PsycINFO, Cochrane and Web of Science were searched (January 1982–November 2022) for Medical Subject Heading terms and synonyms (‘Pain’, ‘Analgesic’, ‘Delirium’). Study eligibility: (1) validated pain measure as exposure, (2) validated delirium tool as an outcome; participant eligibility: (1) medical or surgical (planned/unplanned) inpatients, (2) admission length ≥ 48 h and (3) median cohort age over 65 years. Study quality was assessed with the Newcastle Ottawa Scale. We collected/calculated odds ratios (ORs) for categorical data and standard mean differences (SMDs) for continuous data and conducted multi-level random-intercepts meta-regression models. This review was prospectively registered with PROSPERO [18/5/2020] (CRD42020181346). Results Thirty studies were selected: 14 reported categorical data; 16 reported continuous data. Delirium prevalence ranged from 2.2 to 55%. In the multi-level analysis, pain at rest (OR 2.14; 95% confidence interval [CI] 1.39–3.30), movement (OR 1.30; 95% CI 0.66–2.56), pain categorised as ‘severe’ (OR 3.42; 95% CI 2.09–5.59) and increased pain severity when measured continuously (SMD 0.33; 95% CI 0.08–0.59) were associated with an increased delirium risk. There was substantial heterogeneity in both categorical (I2 = 0%–77%) and continuous analyses (I2 = 85%). Conclusion An increase in pain was associated with a higher risk of developing delirium. Adequate pain management with appropriate analgesia may reduce incidence and severity of delirium.

中文翻译：

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了解老年住院患者疼痛与谵妄之间的关联：系统评价和荟萃分析

目的 谵妄和疼痛在住院的老年人中很常见。这些之间的关系尚不清楚，但在临床上很重要。我们的目的是系统地回顾该人群中疼痛（休息时、运动时、疼痛严重程度）与谵妄之间的关联。方法 在 PubMed、EMBASE、CINAHL、PsycINFO、Cochrane 和 Web of Science（1982 年 1 月至 2022 年 11 月）中搜索医学主题词术语和同义词（“疼痛”、“镇痛”、“谵妄”）。研究资格：(1) 经验证的疼痛测量作为暴露，(2) 经验证的谵妄工具作为结果；参与者资格：(1) 内科或外科（计划/非计划）住院患者，(2) 入院时间≥ 48 小时，(3) 队列中位年龄超过 65 岁。研究质量采用纽卡斯尔渥太华量表进行评估。我们收集/计算了分类数据的比值比 (OR) 和连续数据的标准均差 (SMD)，并进行了多级随机截距元回归模型。该综述已在 PROSPERO 前瞻性注册 [18/5/2020] (CRD42020181346)。结果 选择了 30 项研究：14 项报告了分类数据； 16 报告了连续数据。谵妄患病率为 2.2% 至 55%。在多水平分析中，休息时疼痛（OR 2.14；95% 置信区间 [CI] 1.39–3.30）、运动时疼痛（OR 1.30；95% CI 0.66–2.56）、归类为“严重”的疼痛（OR 3.42；95） % CI 2.09–5.59）和连续测量时疼痛严重程度增加（SMD 0.33；95% CI 0.08–0.59）与谵妄风险增加相关。分类分析 (I2 = 0%–77%) 和连续分析 (I2 = 85%) 均存在显着异质性。结论 疼痛的增加与发生谵妄的风险较高相关。充分的疼痛管理和适当的镇痛可以减少谵妄的发生率和严重程度。