The extent to which the incidence of postoperative acute confusional states could be reduced in elderly (⩾ age 60) patients with hip fractures was tested. Interpersonal and environmental nursing interventions were carried out with 57 patients on orthopedic units in three hospitals. The incidence of confusion was reduced from 51.5% in the comparison group (n= 170) to 43.9%. Analysis that controlled for risk factors in the two groups showed the drop in incidence to be significant (p<.02). The most effective interventions appeared to be those that provided orientation and clarification, corrected sensory deficit, and increased continuity of care.