Latest posts by Sue Walker (see all)
Psychotropic Medicines in Dementia

There has been much discussion regarding the management of behaviours displayed by some persons who have a dementing illness. Indeed, there are a number of articles that identify that the behaviour may be from changes occurring in the person’s brain. However, there is also evidence that the behaviour is associated with the person who has the dementing illness trying to work out what is happening in the situation they find themselves. A change in environment, a change in carer, a change in temperature that they cannot control, a carer talking in an angry tone can all lead to a behavioural response. As can people laughing and the person believing they are laughing at them or unfamiliar people getting too close and the person with dementia believing they are under threat.

In the past, when we knew no better, medication was used to manage symptoms. Now it is evident that this approach caused more problems then it solved. The use of chemical restraint is no longer the first-line treatment to manage behaviours associated with dementia. Indeed there are standards that the aged care residential sector must adhere to in regards to chemical restraint. The restraint requirements in aged care came into effect in July 2019.

Antipsychotics and benzodiazepines

Antipsychotics and benzodiazepines have a very limited role in behaviour management and the Aged Care Quality and Safety Commission has produced guidelines for providers to follow in their use. If all other behavioural modification methods have failed and psychotropic medicines are found to be clinically required then there is a process of documentation and review that includes the person with dementia, their family, the facility, and the prescribing doctor. The effects of the medication should be reviewed frequently to monitor for adverse effects and the ceased of there has been no improvement in 1-2 weeks. Any person who has been on the medication for longer than 12 weeks should have a full review by the medical practitioner. The aged care facility is required to keep a ledger of all Residents who are receiving antipsychotics and benzodiazepines.

NPS Medicine Wise has produced a tool to “facilitate multidisciplinary review of antipsychotic medicines prescribed for patients experiencing BPSD, including advice on how and when to taper.” It can be found here>>

For additional Nursing CPD activities on the subject of restraint in an aged care setting click here>>