Bridging the gap in delirium management: a European comparison of geriatric practices

Aim: To compare diagnostic and therapeutic approaches to delirium across European countries with well-established (WE) versus less-developed (LE) geriatric medicine (GM), to identify similarities, differences and potential gaps in care. Methods: A cross-sectional online survey was conducted among European geriatricians via the European Geriatric Medicine Society and professional networks from July 2023 to March 2024. Responses on delirium diagnosis and management were analyzed quantitatively, with comparisons between WE and LDGM countries. Results: Of 196 hospital-based respondents, 79.1% were from WEGM countries and 20.9% from LDGM countries. Structured delirium screening was significantly more common in WEGM nations, especially in geriatric (88.4% vs 43.9%, p < 0.001) and orthopedic wards. Non-pharmacological strategies—such as hydration support (76.8% vs 52.5%, p = 0.002) and family involvement (81.5% vs 60.4%, p = 0.005)—were also more frequently used. Conversely, physical restraints were more commonly employed in LDGM countries (70.7% vs 41.4%, p < 0.001), as were pharmacological treatments, such as trazodone and quetiapine. Conclusion: Marked differences exist in delirium management across Europe, which may be linked at least in part to GM development, although confounding factors may exist, and causality cannot be assumed. WEGM countries appear to prioritize structured screening and non-pharmacological interventions, whereas LDGM countries rely more on pharmacological treatments. These findings highlight the need for standardized European guidelines to ensure equitable delirium care.