Postoperative delirium in elderly orthopedic patients: a narrative review of prevention and multidisciplinary nursing...

Postoperative delirium (POD) affects 20-60% of elderly orthopedic surgery patients, yet most cases go unrecognized-over 70% in some reports. This gap between what we know and what we do in daily practice is frustrating, but also hopeful: because POD is largely preventable. Early identification and evidence-based prevention remain urgent priorities.

This review brings together recent insights into why POD happens and what bedside nurses and surgical teams can actually do about it. We focus on actionable, non-pharmacological strategies that work in real-world settings.

We searched PubMed and Google Scholar for peer-reviewed studies published between 2022 and 2025, focusing on POD mechanisms, risk prediction, and non-drug interventions. Given the heterogeneity of study designs and outcomes, we used a narrative synthesis approach rather than formal meta-analysis. Twenty high-quality articles were selected for critical appraisal.

POD arises from a tangled web of causes, with neuroinflammation and neurotransmitter imbalance at its core. Newer risk tools can now flag high-risk patients before surgery. The eCASH bundle-Early mobilization, Cognitive stimulation, Adequate sleep, Social support, and Homelike environment-consistently cuts POD rates. Multidisciplinary teamwork works far better than any single discipline going it alone. And while implementation barriers like understaffing and knowledge gaps are real, structured training and simple protocols can overcome them.

A three-part strategy-risk-stratified screening, eCASH bundled interventions, and multidisciplinary collaboration-offers the best shot at reducing POD in elderly orthopedic patients. Looking ahead, biomarkers, remote monitoring, and implementation science will take us further.