Dexmedetomidine is a standout option for preventing postoperative delirium in older adults.

• Overall delirium risk post-surgery is 14.5%.
• Dexmedetomidine shows a significant reduction (odds ratio 0.46) in delirium risk.
• Corticosteroids also reduce delirium severity but do not affect other outcomes like length of stay or mortality.

Be cautious with dexmedetomidine due to potential hypotension and bradycardia. Aim for a balanced approach in drug selection for your surgical patients over 60.

• Other options like melatonin receptor agonists and intranasal insulin show promise but need further validation.