Inadequate pain control, especially in older adults, remains a significant issue when caring for this population. Older adults, many of whom experience multiple acute and chronic conditions, are especially vulnerable to having their pain seriously underassessed and inadequately treated. Nurses have an ethical obligation to appropriately treat patients' pain. To fulfill their ethical obligation to relieve pain in older patients, nurses often need to advocate on their behalf. This article provides an overview of the persistent problem of undertreated pain in older adults and explores how nurses can meet this ethical duty through the application of Beauchamp and Childress' three principles of beneficence.

Background Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. Purpose This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Methods Delirium assessments of a sample of 62 adults age 65 or older were completed on postoperative day 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Results Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Conclusions Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

This study examined the effects of pain and opioid intakes on subsyndromal delirium in older adults who had joint replacement surgery. Delirium assessments of 53 older adults were completed on the first, second, and third days following joint replacement surgery using the Confusion Assessment Method (CAM). Statistical relationships were analyzed using correlations and multiple regressions. Subsyndromal delirium developed in 68% ( n = 36) of participants. Pain was significantly related ( p < .05) to increased delirium symptoms after accounting for preoperative risk factors of comorbidity, cognitive status, fall history, and preoperative fasting times, whereas opioid intake was not significantly associated with increased delirium symptoms. Findings suggest older adults with increased pain levels are at higher risk for subsyndromal delirium as well as delirium after joint replacement surgery.

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.