Preventing and Managing Postoperative Delirium in older adults with Hip Fracture: A Review of Anesthetic Techniques and Multidisciplinary Strategies

Parinyaporn Wattananetikul; Rungrawan  Charoentaisong

Authors

Parinyaporn Wattananetikul Department of Anesthesiology, Kalasin Hospital
Rungrawan Charoentaisong Department of Anesthesiology Kalasin nurse, Kalasin Hospital

Keywords:

postoperative delirium, hip fracture, older adults, anesthesia, multidisciplinary care

Abstract

Postoperative delirium (POD) is one of the most common complications following hip fracture surgery in older adults, affecting approximately 35–65% of patients, and is associated with increased mortality, prolonged hospitalization, functional decline, cognitive impairment, and substantial healthcare costs. This review aimed to synthesize current evidence regarding perioperative strategies for the prevention and management of POD in older adults undergoing hip fracture surgery, with a focus on anesthetic techniques, pharmacological interventions, non-pharmacological measures, and multidisciplinary care. Evidence was retrieved from PubMed, Google Scholar, and SciSpace, covering publications from 2009 to 2025, and included randomized controlled trials, systematic reviews, narrative reviews, meta-analyses, observational studies, and relevant clinical practice guidelines. Current evidence indicates that multicomponent perioperative interventions represent the most effective strategy for preventing POD: proactive geriatric consultation reduces the incidence of POD from 50% to 32% (RR 0.64, 95% CI 0.37–0.98); individualized anesthetic management, including regional anesthesia combined with peripheral nerve blocks in appropriate patients and multimodal analgesia, may further reduce the risk; and perioperative melatonin administration has demonstrated promising results, reducing POD incidence from 32.7% to 9.4% in selected studies, while non-pharmacological interventions—early mobilization, effective pain management, sleep promotion, environmental optimization, nutritional and sensory support, routine delirium screening using validated tools, and coordinated multidisciplinary care—are consistently identified as essential components of successful POD prevention. In conclusion, POD in older adults with hip fracture is a common but potentially preventable complication, and early risk assessment together with evidence-based multicomponent perioperative interventions—including individualized anesthetic and pain management strategies, appropriate pharmacological therapy, routine delirium screening, and coordinated multidisciplinary care—is essential for reducing its incidence and improving clinical outcomes in this vulnerable population.

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