Objective: To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors. Methods: A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected. Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Results: The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%. Logistic regression analysis showed that gender, length of stay in the ICU, and duration of sedative drug use were independent risk factors for delirium in elderly patients (P < 0.05). The model likelihood ratio test χ² = 28.462, P < 0.001; Hosmer-Lemeshow goodness-of-fit test χ² = 0.715, P = 0.878. Conclusion: The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low. Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients, and use analgesic and sedative drugs reasonably to create a good treatment environment for patients, thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.