Post-Operative Delirium in Elderly Patients: A Narrative Review

Smirnov, Alexander; Semionov, Michael; Yasinski, Valery; Binyamin, Yair; Zlotnik, Alexander; Frank, Dmitry

doi:10.3390/ijms262311314

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Post-Operative Delirium in Elderly Patients: A Narrative Review

by

Alexander Smirnov

^†

,

Michael Semionov

^†

,

Valery Yasinski

,

Yair Binyamin

,

Alexander Zlotnik

and

Dmitry Frank

^*

Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 8410501 Beer-Sheva, Israel

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Int. J. Mol. Sci. 2025, 26(23), 11314; https://doi.org/10.3390/ijms262311314 (registering DOI)

Submission received: 5 September 2025 / Revised: 18 November 2025 / Accepted: 20 November 2025 / Published: 22 November 2025

(This article belongs to the Special Issue Neurological Diseases: From Molecular Basis to Therapy)

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Abstract

Anesthesia in older patients is challenging and requires a range of skills in various techniques, both during surgery and in the post-operative period. Post-operative delirium is one of the most common cognitive dysfunctions after surgery, and elderly patients are at the highest risk. The pathophysiology of post-operative delirium remains incompletely understood. Several mechanisms (vascular, neurodegenerative, neuroimmune, neuroinflammation, drug-induced, stress-induced, and monoaminergic) have been considered to play a role. The type of anesthesia—general (gas, total intravenous), regional, or combined—was identified as a predictive factor. However, numerous prospective and retrospective studies have failed to determine which anesthetic technique is the best for preventing post-operative delirium. The type of surgery appears to be more critical than the type of anesthesia. However, the development of post-operative cognitive dysfunction could be linked to the depth of anesthesia. Dexmedetomidine displayed promising therapeutic potential for the efficient prevention or treatment of hyperactive post-operative delirium. The management of hypoactive post-operative delirium still requires further investigations, particularly in elderly patients.

Keywords: elderly patients; postoperative cognitive dysfunction; delirium; general anesthesia

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MDPI and ACS Style

Smirnov, A.; Semionov, M.; Yasinski, V.; Binyamin, Y.; Zlotnik, A.; Frank, D. Post-Operative Delirium in Elderly Patients: A Narrative Review. Int. J. Mol. Sci. 2025, 26, 11314. https://doi.org/10.3390/ijms262311314

AMA Style

Smirnov A, Semionov M, Yasinski V, Binyamin Y, Zlotnik A, Frank D. Post-Operative Delirium in Elderly Patients: A Narrative Review. International Journal of Molecular Sciences. 2025; 26(23):11314. https://doi.org/10.3390/ijms262311314

Chicago/Turabian Style

Smirnov, Alexander, Michael Semionov, Valery Yasinski, Yair Binyamin, Alexander Zlotnik, and Dmitry Frank. 2025. "Post-Operative Delirium in Elderly Patients: A Narrative Review" International Journal of Molecular Sciences 26, no. 23: 11314. https://doi.org/10.3390/ijms262311314

APA Style

Smirnov, A., Semionov, M., Yasinski, V., Binyamin, Y., Zlotnik, A., & Frank, D. (2025). Post-Operative Delirium in Elderly Patients: A Narrative Review. International Journal of Molecular Sciences, 26(23), 11314. https://doi.org/10.3390/ijms262311314

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