Pharmacological Interventions for Managing Acute Geriatric Pain and Delirium: A Systematic Review.

Abstract

Delirium and acute pain are significant clinical challenges in the care of hospitalised elderly patients, both of which are associated with increased mortality, functional disability and prolonged hospital stays. The aim of this study was to systematically review and perform both qualitative and quantitative analyses of the effectiveness of various pharmacological interventions in preventing delirium and controlling acute pain in hospitalised elderly individuals. A comprehensive search was conducted in PubMed, Scopus, Embase, Cochrane, Google Scholar and Web of Science databases up to February 2025. Randomised controlled trials (RCTs) and controlled trials focusing on medications used to prevent delirium or alleviate pain in hospitalised elderly patients were selected. Data were extracted qualitatively and categorised and analysed considering delirium and pain outcomes. Among the studies screened, 12 studies were included in the final analysis. Interventions such as iliac fascia block, multi-drug anti-inflammatory bundles, gabapentin and butorphanol were effective in reducing pain intensity and some inflammatory markers. However, most medications had no significant effect on reducing delirium incidence or provided conflicting results. Interventions targeting systemic inflammation, such as methylprednisolone, dexamethasone and preoperative saline solution, showed more promising results in preventing delirium. The findings suggest that single pharmacological approaches are often ineffective in preventing delirium and the use of combined strategies, including anti-inflammatory interventions along with effective pain control, may yield better outcomes. Future study designs should focus on larger sample sizes, more diverse populationsand standardisation of measurement tools.