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The number of older people who undergo complex surgical procedures continues to rise. Old age is a significant risk factor for the development of postoperative neurocognitive decline which can lead to problems with performing daily activities and maintaining independence. The purpose of this study is to evaluate if the PeriBrainCare bundle has a positive effect on older people’s postoperative cognitive recovery after cardiac surgery. The aim is, to test if the PeriBrainCare bundle reduces postoperative cognitive complaints as reflected in postoperative symptoms and symptoms burden.This intervention will be nested in an ongoing trial performed by the PeriBrainCare group 2025-2029. A pragmatic stepwise cluster randomized study with data collection at two Thoracic clinics in Sweden, 220 participants ≥65 years old with a relative will be included. The PeriBrainCare bundle is based on international recommendations, guidelines, and research and contains three components: Preoperative patient education, a postoperative follow-up, and evaluating cognitive symptoms and complaints. Primary outcome is neurocognitive complaints, secondary outcomes are factors associated with cognitive decline, delirium, depression, functioning in daily life, frailty, and health economics. Patient´s and next of kin´s experiences will be assessed and evaluated. The results will have immediate relevance for a substantial number of older persons undergoing surgery, and their close relatives.

The society is ageing and advantages in anesthesia and surgery allows more complex interventions in older persons. Old age is a significant risk factors for the development of postoperative neurocognitive decline characterized by a gradual decrease in performance in several cognitive domains such as memory, attention, information processing and executive functions, leading to problems with performing daily activities and maintaining independence and postoperative complications.  The purpose is to measure older persons’ postoperative neurocognitive function, to detect neurocognitive decline, and to identify risk factors and difficulties in daily living as well as explore close relatives’ experiences of it.A longitudinal observational mixed method study including 200 participants ≥65 years of age undergoing planned cardiac surgery in two different Thoracic surgery departments. Neurocognitive function will be assessed with a digital neurocognitive test battery, seven times over three years postoperatively. Risk/affected factors such as delirium, functional status, recovery, health literacy depression, unplanned healthcare visits and frailty as well as patients and close relative’s symptom burden experiences will be measured.The results will have immediate relevance for a substantial number of older persons undergoing surgery, and their close relatives, by enhanced knowledge about postoperative cognitive decline/recovery and support to be implemented