Which of the following strategies helps reduce delirium risk in older adults postoperatively?

• A. Promote early mobility
• B. Improve nutrition
• C. Limit fluids
• D. Ensure proper sleep hygiene

Answer: (D)

Delirium after surgery in older adults is strongly driven by sleep disruption and circadian misalignment. Ensuring proper sleep hygiene directly targets this modifiable factor by promoting a continuous, restorative night’s sleep, which helps stabilize cognitive function and neurotransmitter balance during recovery. When the sleep–wake cycle is preserved, the brain experiences fewer episodes of confusion and disorientation that contribute to delirium.

Practical nursing actions that support this include clustering care to avoid unnecessary awakenings, keeping the environment quiet and dim at night, maintaining a consistent bed and wake time, and optimizing pain control with non-sedating strategies. Avoiding or minimizing sedating medications and limiting nighttime disturbances further protect sleep quality.

While early mobility and good nutrition support overall recovery and can influence delirium risk, sleep disruption is a particularly strong, modifiable factor. Limiting fluids is not a strategy to prevent delirium and can worsen dehydration, which may increase delirium risk.