[Multicomponent programs in delirium prevention and delirium management in older adults : Evidence, guideline recommendations and perspectives on delirium-sensitive care].

Delirium is among the most frequent neuropsychiatric complications in older people. It is associated with functional decline, increased morbidity and mortality, loss of independence, cognitive deterioration and an elevated risk of dementia. Contemporary concepts view delirium as the result of an interplay between predisposing vulnerability factors and acute physiological stressors. Current approaches to delirium prevention and management focus on nonpharmacological multicomponent interventions that combine early mobilization, cognitive reorientation, sleep hygiene, pain management, optimization of nutrition and hydration, delirium screening and family involvement. Programs such as HELP, ABCDE(F) bundle, CHOPS and AKTIVER have shaped the development of evidence-based delirium prevention. The strongest evidence to date derives from two meta-analyses published in 2026. In these studies, nonpharmacological multicomponent programs reduced delirium incidence by 44% and significantly shortened delirium duration in patients with established delirium. In contrast, pharmacological strategies demonstrated inconsistent or limited benefits. Only dexmedetomidine showed a preventive effect in selected perioperative settings. The current German S3 guidelines "Delirium in older age" therefore strongly recommend structured, interdisciplinary and person-centered delirium programs. Future challenges include comprehensive implementation, the development of specialized concepts for high-risk populations, improved cross-sectoral care pathways and the meaningful integration of digital technologies. A delirium-sensitive hospital culture should become a key quality indicator not only in geriatric medicine but also in inpatient care across all clinical disciplines.