Frailty, delirium, and cognitive change

Postoperative delirium (POD)

Delirium is an acute disturbance of attention and cognition, often fluctuating over hours. It is common in older adults after major surgery, with reported incidence varying widely by population and surgery type.

Risk factors

• Older age and frailty
• Pre-existing cognitive impairment or dementia
• Infection, dehydration, pain, sleep disruption
• High-risk surgery (major vascular, orthopaedic, cardiac), ICU admission
• Polypharmacy (especially sedatives, anticholinergics), alcohol withdrawal

Prevention and treatment (high-level)

• Optimize hydration, oxygenation, and pain control (opioid-sparing strategies when feasible)
• Early mobilization, sleep hygiene, orientation cues (glasses/hearing aids)
• Avoid or minimize deliriogenic medications when possible
• Treat underlying triggers (infection, urinary retention, hypoxia, metabolic derangements)

Longer-term cognitive concerns

Some patients report memory or concentration issues after surgery. In many cases this is transient; in others, surgery/illness may unmask pre-existing cognitive decline. If new neurological signs occur (focal weakness, severe headache, seizure, persistent reduced consciousness), clinicians may investigate for stroke/bleed and consider CT/MRI.