Please select the eligibility criteria that correspond to the clinical trial below.
Title: Non-pharmacological Prevention of Postoperative Delirium by Occupational Therapy Teams in Patients Older Than 75 Years Undergoing High-risk Elective Surgery
Brief Summary: In the world, 230 million surgeries are performed every year and US data indicates that more than a third of patients who undergo surgery are older than 65 years, in which between 10 and 70% develop postoperative delirium (POD). Patients who develop POD have poor outcomes, such as a longer hospital stay, a deterioration in functional and cognitive status, high mortality rates, and an increase in health costs.

Delirium is an entity that in a significant percentage is preventable, thus preventing the development of POD is fundamental. In fact, in older adults hospitalized in the no surgical ward, the implementation of non-pharmacological prevention measures of delirium has consistently shown to significantly prevent the development of this condition. However, limited information is available about the usefulness of non-pharmacological intervention protocols applied in the perioperative context to prevent POD.

The main aim of this project is to determine whether the application of non-pharmacological measures during the perioperative period prevents POD in elderly patients undergoing highly complex elective surgeries.

The hypothesis is that the application of these measures decreases the incidence of delirium in this population.


Options:
A: Inclusion Criteria:

* Has undergone surgical repair for a hip fracture
* Has a postoperative Hgb level below 10 g/dL within three days of surgery
* Diagnosis of cardiovascular disease (e.g., coronary artery disease, congestive heart failure, stroke or transient ischemic attack, or peripheral vascular disease) or cardiovascular risk factors (e.g., diabetes mellitus, hypertension, hypercholesterolemia, tobacco use, or creatinine levels greater than 2.0 mg/dL)

Exclusion Criteria:

* Unable to walk prior to hip fracture
* Declines blood transfusions
* Suffered multiple traumas
* Pathologic fracture of the hip due to malignancy
* Clinically recognized acute myocardial infarction within the 30 days prior to study entry
* Previously participated in the trial and fractured the other hip
* Symptoms associated with anemia (e.g., ischemic chest pain) or actively bleeding at the time of randomization
B: Inclusion Criteria:

* On a daily basis during the study period (weekdays from 7am to 5pm), each operating room of Barnes-Jewish Hospital (BJH) will be eligible for randomization, which will occur at the level of the operating room using computer-generated assignment.

Exclusion Criteria:

-
C: Inclusion Criteria:

* Hospital admission for highly complex elective surgery

Exclusion Criteria:

* History of cognitive impairment.
* A low score in Mini-Mental State Examination (MMSE): \<23 points if the patient has 6 or more years of schooling, and \<18 points if the patient has \<6 years of schooling.
* Severe communication disorder and cultural language limitation (language other than Spanish).
* Delirium on admission or prior to the start of the intervention (measured with CAM).
* Patient enrolled in another study
D: Inclusion Criteria

1. 60 years of age or older
2. Capable and willing to consent
3. Non-cardiac/non-neurological surgery with expected hospital stay of at least 72 H
4. American Society of Anesthesiologists (ASA) physical status I-IV
5. English speaking
6. Willingness to use a provided tablet device
7. Willingness to commit at least 1 hour per day to experimental intervention (cognitive activity/exercise) to complete a minimum of 10 hours within at least 8 days prior to surgery.

Exclusion criteria

1. Severe visual or auditory deficits
2. Illiterate
3. Surgery within the previous 6 months requiring general anesthesia
4. Score \< 26 on initial Mini Mental Status Exam (MMSE - modified version) (24 for patients with less than high school education)
5. Positive pre-surgery Confusion Assessment Method test (CAM)
6. Active depression as indicated by Geriatric Depression Scale screening test (score ≥ 10)
7. History of Axis I or II psychiatric disorders including bipolar disorder, schizophrenia, dementia, alcohol or drug abuse
8. ASA physical status V, VI
9. Planned postoperative intubation

Answer: C