Objective:

To review recent insights into the causes of postoperative delirium (POD) and actionable non-pharmacological strategies for prevention in elderly orthopedic surgery patients.

Approach:

• Literature Search: Searched PubMed and Google Scholar for peer-reviewed studies published between 2022 and 2025, focusing on POD mechanisms, risk prediction, and non-drug interventions.
• Narrative Synthesis: Used a narrative synthesis approach for critical appraisal of twenty high-quality articles due to heterogeneity in study designs and outcomes.

Key Findings:

• POD affects 20–60% of elderly orthopedic surgery patients, with over 70% of cases going unrecognized.
• Core mechanisms of POD include neuroinflammation and neurotransmitter imbalance.
• New risk tools can identify high-risk patients before surgery.
• The eCASH bundle (Early mobilization, Cognitive stimulation, Adequate sleep, Social support, Homelike environment) effectively reduces POD rates.
• Multidisciplinary teamwork is more effective than single-discipline approaches.

Interpretation:

A three-part strategy involving risk-stratified screening, eCASH bundled interventions, and multidisciplinary collaboration is recommended to reduce POD in elderly orthopedic patients.

Limitations:

• Implementation barriers such as understaffing and knowledge gaps exist.
• The review does not include a formal meta-analysis due to study heterogeneity.

Conclusion:

Future advancements may include biomarkers, remote monitoring, and implementation science to further reduce POD.