Background <p>Delirium is a frequent and serious condition in older adults in long-term care (LTC), often underdiagnosed and insufficiently addressed despite its significant impact on morbidity and mortality. Occupational therapists (OTs) may play a key role in non-pharmacological prevention and treatment approaches, yet their specific contribution may remain unclear and undervalued in clinical practice.</p> Objective <p>This study explored the perceptions of geriatricians and OTs regarding the role of OT in delirium care in LTC settings across three European countries.</p> Methods <p>A qualitative, multi-site study was conducted through semi-structured interviews with six geriatrician–occupational therapist dyads working in LTC settings in Italy, Spain, and Switzerland. Transcripts were analyzed thematically through inductive coding.</p> Results <p>Three main conceptual categories emerged: (1) the perceptions of the OT’s role by geriatricians, (2) the goals and interventions of OTs in delirium care, and (3) barriers and facilitators to OT involvement. Geriatricians with greater familiarity with OTs recognized their role in prevention through environmental modifications and meaningful activity promotion, whereas others saw OTs’ contributions as overlapping with physiotherapy. OTs often lacked standardized tools and specific training for delirium care, and caregiver involvement was minimal. Barriers included time constraints, unclear interprofessional roles, and limited geriatric training; facilitators included strong interdisciplinary collaboration and supportive teams.</p> Conclusion <p>Enhancing the role of occupational therapy in delirium care requires clearer interprofessional definitions, dedicated training, and structural support in LTC. Structured collaboration between geriatricians and OTs may improve prevention and management outcomes for delirium in older adults.</p>