Prevention of Postoperative Delirium in Elderly Hip Surgery Patients through Preoperative Physical and Cognitive Interventions: A Combined Retrospective and Prospective Study.

PURPOSE: This study aimed to (1) identify modifiable preoperative risk factors for postoperative delirium (POD) in elderly patients undergoing hip surgery under general anesthesia, and (2) evaluate the feasibility and potential effectiveness of a nurse-led, home-based physical and cognitive intervention to prevent POD. DESIGN: A two-phase mixed-method study was conducted, consisting of a retrospective cohort analysis (Phase 1) and a prospective non-randomized interventional study with historical controls (Phase 2). Phase 1 analyzed 42 patients aged ≥70 years to identify preoperative risk factors. Phase 2 evaluated a 14-day home-based exercise and cognitive training program (59 intervention; 79 controls). FINDINGS: Phase 1 identified preoperative bed rest (OR = 6.66, P =.03) and inadequate comprehension of orientation materials (OR = 18.17, P =.02) as significant POD risk factors. In Phase 2, POD occurred in 5.1% of the intervention group versus 12.7% of controls (P =.153). Adherence was high: 69.5% completed exercise training, 76.3% completed cognitive training, and 64.4% achieved full completion of both intervention components. No adverse events were reported. Although statistical significance was not reached, a trend toward reduced POD incidence was observed. CONCLUSIONS: A nurse-led, dual-component preoperative intervention combining physical and cognitive training demonstrated high feasibility, strong adherence, and potential clinical applicability in elderly hip surgery patients. These findings support further investigation of scalable non-pharmacological perioperative strategies for POD prevention.