In managing pain in older adults at risk for delirium, what approach regarding opioid use is recommended?

• A. Use a balanced approach with multimodal strategies to minimize opioid use
• B. Use high-dose opioids for rapid relief
• C. Avoid pain management
• D. Avoid multimodal approaches

Answer: (A)

In older adults at risk for delirium, the best approach is multimodal analgesia that minimizes opioid exposure. This means using nonopioid options (for example, acetaminophen as a baseline, plus other nonopioid or regional strategies and adjuvants when appropriate) so that pain relief comes from multiple mechanisms and opioids can be reduced or avoided. If opioids are necessary, use the lowest effective dose for the shortest possible duration and monitor closely for delirium and other side effects. This approach provides adequate pain control while lowering the risk of delirium, rather than relying on high-dose opioids, neglecting pain, or skipping multimodal strategies.