{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T21:46:15Z","timestamp":1773870375975,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2019 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\u2019 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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1093\/ageing\/afag056","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:30:09Z","timestamp":1773844209000},"source":"Crossref","is-referenced-by-count":0,"title":["\u2018Just a delirium\u2019: a qualitative study of care home managers\u2019 perspectives on barriers to delirium recognition and management in UK care homes"],"prefix":"10.1093","volume":"55","author":[{"given":"Olivia J","family":"Russell","sequence":"first","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences , Newcastle upon Tyne, NE2 4AX, England ,","place":["UK"]},{"name":"School of Health and Life Sciences, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamar E","family":"Ameen-Ali","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8438-1506","authenticated-orcid":false,"given":"Angela C","family":"Flynn","sequence":"additional","affiliation":[{"name":"School of Population Health, RCSI University of Medicine and Health Sciences , Dublin 2, D02 YN77 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Barnes","sequence":"additional","affiliation":[{"name":"Sheffield Centre for Health and Related Research, University of Sheffield , Sheffield, S1 4DA, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Ferguson","sequence":"additional","affiliation":[{"name":"School of Social Sciences, Humanities & Law, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Divers","sequence":"additional","affiliation":[{"name":"School of Social Sciences, Humanities & Law, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothy","family":"Newbury-Birch","sequence":"additional","affiliation":[{"name":"School of Social Sciences, Humanities & Law, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-178X","authenticated-orcid":false,"given":"Judith","family":"Eberhardt","sequence":"additional","affiliation":[{"name":"School of Social Sciences, Humanities & Law, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S","family":"Young","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mani Santhana","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Lustrum Vale, Tees Esk and Wear Valleys NHS Foundation Trust , Durham Road, Stockton-on-Tees, TS19 0EA, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4835-5359","authenticated-orcid":false,"given":"Ahmad A","family":"Khundakar","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences, Teesside University , Middlesbrough, TS1 3BX, England ,","place":["UK"]},{"name":"Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University , Newcastle upon Tyne, NE2 4HH, England ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026031810300146500_ref1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425787","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. 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Ed","author":"American Psychiatric Association ib","year":"2022"},{"key":"2026031810300146500_ref2","volume-title":"Delirium, ICD-11 Code 6D70","author":"Organization WH","year":"2025"},{"key":"2026031810300146500_ref3","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.archger.2010.04.012","article-title":"Delirium in long-term care setting: indicator to severe morbidity","volume":"52","author":"Arinzon","year":"2011","journal-title":"Arch Gerontol Geriatr"},{"key":"2026031810300146500_ref4","doi-asserted-by":"publisher","first-page":"875196","DOI":"10.1155\/2011\/875196","article-title":"A clinical update on delirium: from early recognition to effective management","volume":"2011","author":"Cerejeira","year":"2011","journal-title":"Nurs Res Pract"},{"key":"2026031810300146500_ref5","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1001\/jama.2010.1013","article-title":"Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis","volume":"304","author":"Witlox","year":"2010","journal-title":"JAMA"},{"key":"2026031810300146500_ref6","doi-asserted-by":"publisher","first-page":"afaf188","DOI":"10.1093\/ageing\/afaf188","article-title":"Long-term clinical outcomes of delirium after hospital discharge: a systematic review and meta-analysis","volume":"54","author":"Tesfaye","year":"2025","journal-title":"Age Ageing"},{"key":"2026031810300146500_ref7","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"2026031810300146500_ref8","doi-asserted-by":"publisher","first-page":"j2047","DOI":"10.1136\/bmj.j2047","article-title":"Hypoactive delirium","volume":"357","author":"Hosker","year":"2017","journal-title":"BMJ"},{"key":"2026031810300146500_ref9","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1038\/s41582-022-00698-7","article-title":"The inter-relationship between delirium and dementia: the importance of delirium prevention","volume":"18","author":"Fong","year":"2022","journal-title":"Nat Rev Neurol"},{"key":"2026031810300146500_ref10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.jamda.2016.07.014","article-title":"The diagnosis of delirium superimposed on dementia: an emerging challenge","volume":"18","author":"Morandi","year":"2017","journal-title":"J Am Med Dir Assoc"},{"key":"2026031810300146500_ref11","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"2026031810300146500_ref12","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1111\/jgs.14823","article-title":"Delirium during Postacute nursing home admission and risk for adverse outcomes","volume":"65","author":"Kosar","year":"2017","journal-title":"J Am Geriatr Soc"},{"key":"2026031810300146500_ref13","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1111\/ajag.12452","article-title":"Delirium in a residential care facility: an exploratory study of staff knowledge","volume":"36","author":"Buettel","year":"2017","journal-title":"Australas J Ageing"},{"key":"2026031810300146500_ref14","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1017\/S1463423618000105","article-title":"Recognition of the complexity facing residential care homes: a practitioner inquiry","volume":"19","author":"Dudman","year":"2018","journal-title":"Prim Health Care Res Dev"},{"key":"2026031810300146500_ref15","doi-asserted-by":"publisher","first-page":"jltc.87","DOI":"10.31389\/jltc.87","article-title":"Facilitators and barriers to research participation in care homes: thematic analysis of interviews with researchers, staff, residents and residents\u2019 families","volume":"0","author":"Law","year":"2022","journal-title":"J Long-Term Care"},{"key":"2026031810300146500_ref16","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1186\/s12877-023-03935-w","article-title":"Registered care home managers\u2019 experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; 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