Which measures help mitigate postoperative delirium risk in older adults?

• A. Increased narcotic dosing to ensure sleep.
• B. Prolonged bed rest and isolation.
• C. Adequate pain control, hydration, sleep hygiene, early mobilization, minimize polypharmacy; monitor cognition.
• D. Ignoring cognitive assessment.

Answer: (C)

Mitigating postoperative delirium in older adults hinges on addressing modifiable perioperative factors with a comprehensive, nonpharmacologic care plan. Adequate pain control is essential because undertreated pain can lead to agitation and the need for sedatives, while using multimodal analgesia helps limit opioid exposure and sedation. Ensuring good hydration and stable electrolytes supports brain function and reduces delirium triggers. Sleep hygiene matters because irregular or disrupted sleep-wake cycles strongly contribute to delirium; strategies like minimizing nighttime awakenings, quiet environments, and appropriate lighting help maintain orientation and circadian rhythm. Early mobilization promotes circulation, prevents complications from immobility, and reinforces daytime activity and wakefulness, all of which lower delirium risk. Minimizing polypharmacy involves reviewing medications to reduce those with anticholinergic or sedative effects and avoiding unnecessary drugs, which can cloud cognition. Finally, actively monitoring cognition preoperatively and postoperatively allows for early detection and timely management of delirium, improving outcomes. In contrast, strategies like increasing narcotic dosing, prolonged bed rest, isolation, or ignoring cognitive assessment would raise delirium risk or delay its identification, making them unsuitable.