Knowledge translation for delirium superimposed on dementia care: a realist review

People living with dementia are at higher risk of developing delirium during healthcare admission. While there have been advancements in delirium interventions, challenges persist in translating evidence-based knowledge into practice. This review aims to explore the contextual factors and underlying mechanisms of knowledge translation for preventing and managing delirium in people with dementia, and to understand how these processes contribute to intended outcomes.

A realist synthesis was adopted to construct context-mechanism-outcome configurations exploring the processes of knowledge translation. Five databases were searched from inception till May 2024 and updated in September 2025. Study screening and selection were performed independently, and quality was appraised based on content relevance, richness, and rigor. Data were extracted and synthesized to define and redefine the program theory using the Knowledge-to-Action cycle framework.

Of 4,142 articles identified, 31 studies were included. Four themes emerged: time constraints, awareness and knowledge of delirium and dementia, treatment effectiveness, and feasibility and sustainability of implementation. Eight context-mechanism-outcome configurations were constructed under the four themes: integration into existing practice, dedicated personnel, partnership with direct stakeholders, iterative education and training, effective leadership, acknowledging pharmacological and non-pharmacological mixed effects, ongoing attention to feedback and collaborative efforts.

Based on the constructed context-mechanism-outcome, recommendations for future implementation of delirium interventions were summarized to support knowledge translation in caring for older people with dementia, with or at risk of delirium. Further exploration of synthesized findings in real-world settings is needed to strengthen the evidence-informed theory.