Dementia Series: Dr Michael Pearcy

Dr Michael Pearcy attended the ‘Dementia in Residential Aged Care Forum: Navigating the Challenging Impacts’ event hosted by GCPHN in partnership with Gold Coast Health in May. These were his key takeaways from the range of topics that were discussed throughout the event by a range of speakers, all with some area of special interest in managing dementia behaviours in RACH settings.

• Delirium always has a cause, and usually manifests as impaired alertness, psychomotor agitation, fluctuations in behaviour, inattention and distraction, either hyperactive hypoactive or mixed, and carries 5-year 50% mortality. It involves environmental, iatrogenic and patient factors; with changes in appetite, sleep, mood and sometimes hallucinations. Should be investigated fully to exclude organic causes.
• When treating Behavioural and Psychological Symptoms of Dementia (BPSD), consider regular paracetamol to treat physical pain which may trigger abnormal behaviours.
• If antipsychotic treatment is needed, then use Risperidone as the first line of treatment at the lowest possible dose for no more than 3 months. Antidepressants may have a place in those with low mood. Benzodiazepines may be needed as a PRN but use Oxazepam or Temazepam, with shorter half-life. Could also consider mood stabilizer such as Valpro, Tegretol or Lithium. Haloperidol should only be used in risky cases where urgent sedation needed.
• GPs working in RACHs do not need to comply with multiple Restrictive Practice forms except for chemical restraint. Take appropriate steps to document consent and duration, and plan for review in patient’s notes. Ensure to discuss with family, Power Of Attorney etc. Bed rails can be used as long as the family & POA give written permission.
• Dementia Support Australia (DSA) has a 24-hour number for GP’s seeking advice on 1800 699 799. This is an excellent resource. In addition, GPs can refer patients directly for advice or even RACH visits by DSA Specialists, by using referral template on the DSA website.
• Older Persons Mental Health Community Services (OPMHCS) on the Gold Coast accepts referrals for mental health issues where dementia is not the primary diagnosis, and where there is a need for support in the community with diagnosis and management.