Delirium in German Nursing Homes – a qualitative study of care practice from the perspective of nurses and general practitioners

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BACKGROUND: Delirium is a multifactorial and potentially life-threatening syndrome that remains underdiagnosed and undertreated in nursing homes, despite residents' high vulnerability due to advanced age, multimorbidity and cognitive impairment. To date, little is known how healthcare professionals perceive and manage delirium in these settings, particularly regarding prevention, diagnosis, therapy and interdisciplinary collaboration, as well as differentiation from other neurodegenerative diseases. This study explores the perspectives of nurses and general practitioners (GPs) on the quality of delirium care in German nursing homes in order to identify barriers and opportunities for improvement. METHODS: An exploratory qualitative design was employed. A total of 30 semi-structured interviews were conducted with 15 nurses and 15 GPs in Germany. Participants were recruited using a criterion-based purposive sampling strategy to ensure their direct involvement in nursing home care. Data were collected using collaboratively developed interview guides and analyzed using qualitative content analysis with a deductive-inductive approach. RESULTS: Both nurses and GPs reported uncertainty and variability in the understanding, recognition and management of delirium in nursing homes. While preventive and other non-pharmacological measures were applied intuitively, they were rarely identified as delirium-specific. Both professions highlighted limited knowledge and training, unclear responsibilities and the absence of standardized tools as major barriers to effective care. Diagnostic practices were largely based on clinical impression rather than structured assessments. Interprofessional and interdisciplinary cooperation was considered essential but was often hindered by organizational factors and individual attitudes. Participants also emphasized the value of involving relatives and other significant others in the care process but noted that this was inconsistent. CONCLUSION: Delirium care in German nursing homes is non-standardized and marked by substantial variability in practice and outcomes. Although individual nurses and GPs recognize the challenges and apply some effective routines intuitively, care remains insufficiently systematic and rarely guided by standardized strategies in general. Addressing knowledge gaps, improving interprofessional communication and implementing structured care pathways are crucial steps toward enhancing the prevention, diagnosis and therapy of delirium in these settings.

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