Non-Pharmacological Approaches for Reducing Postoperative Cognitive Dysfunction and Postoperative Delirium

More than 50 million Americans undergo surgery annually, many of whom may develop postoperative cognitive dysfunction (POCD) or postoperative delirium (POD). Patients with POCD or POD have longer hospital and intensive care unit stays, and higher mortality rates, than patients without these syndromes. Although various risk factors have been identified, many of these factors, such as age and education level, are not modifiable. Currently, effective, practical approaches to decrease POCD and POD remain to be established. Medications such as dexmedetomidine may be useful, but inconsistent findings have been reported. Non-pharmacological approaches are promising and might have advantages over pharmacological approaches. Because older patients may already take multiple medications, further adding medications can pose difficulties and risks of adverse drug-drug interactions. This article focuses on enriched environment, a non-pharmacological approach with potentially minimal adverse effects. The roles of family members in surgical patients’ brain health are further discussed. Large well-designed clinical studies remain necessary to determine the effectiveness of various approaches to decrease POCD and POD.