'Just a delirium': a qualitative study of care home managers' perspectives on barriers to delirium recognition and management in UK care homes.

Delirium is a common but frequently under-recognised neuropsychiatric syndrome in care homes, especially among residents living with dementia. Delirium is associated with substantial morbidity, mortality and preventable healthcare complications, yet evidence on how it is recognised and managed in residential care remains limited. This qualitative study explored care home managers' perspectives on delirium care within privately owned care homes in a region of England, UK, and data analysed thematically to identify key challenges and opportunities for improvement. Three overarching themes were identified: (1) Recognising and Responding to Delirium described how detection often relied on staff familiarity with residents' usual behaviour, with limited use of formal assessment tools and frequent difficulty distinguishing delirium from dementia, particularly in hypoactive presentations.(2) Systemic Barriers to Quality Care highlighted the impact of chronic underfunding, fragmented communication at hospital discharge, unclear clinical responsibility and limited access to training and clinical support.(3) Collaborative Care and Support Networks captured the role of families and external professionals in delirium management, with variable communication, inconsistent validation of care home concerns and challenges coordinating care across services. In response to these challenges, we recommend co-produced delirium education for care staff, clearer clinical pathways and stronger interprofessional collaboration to ensure that delirium is recognised and treated as a potentially life-threatening medical emergency.