To receive important alerts and updates from Gold Coast Primary Health Network, please submit the form below.
To receive important alerts and updates from Gold Coast Primary Health Network, please submit the form below.
Recently I attended a full day workshop on navigating the challenging impacts of managing dementia in Residential Aged Care Homes. This workshop was attended by GP’s, RACH staff and managers, and representatives from Gold Coast Health, police, paramedics, Dementia Support Australia and the Aged Care Quality and Safety Commission.
As a GP there is often pressure when seeing a patient with challenging behaviours to prescribe medication as the first action. This workshop reinforced the importance of a proper assessment and evaluation to exclude causes like delirium, and that non-pharmacological interventions are the gold standard for first line management. The goals are always to control symptoms, improve quality of life and reduce caregiver burden.
Challenges in using medication if this is being considered are individual variability (what works in one resident may not work in another), a limited evidence base and multiple adverse effects. If medication is used, non-pharmacological strategies should be continued alongside. The first step is always to treat any causative or contributing factors.
The medications that are utilised in these residents include antipsychotics, antidepressants, anxiolytics and mood stabilisers. In general, antipsychotics are overused for BPSD. Only one in five patients with dementia will get any benefit, and they can increase the risk of stroke, pneumonia and fractures. The only PBS approved antipsychotic for BPSD is risperidone, but only for up to 12 weeks use. These drugs are often used for too long and should be regularly reviewed.
The behaviours that are targeted for treatment with medications need to be considered. Medications are ineffective in treating inattention, wandering, repetitive vocalisations/yelling out and unfriendliness. Symptoms of psychosis (hallucinations and delusions) are the main indication for using antipsychotics in these residents.
The workshop reinforced that non-pharmacological treatments are first line. Medications should be reserved for severe, more risky cases and that treatment plans should be individualised and regularly reviewed. It is always worth getting further advice from support services such as visiting geriatricians, Dementia Support Australia and the RaSS (residential aged care support services) team from Gold Coast Health.
Dr Andrew Weissenberger
Hope Island Medical Centre
So we can provide you with the most accurate information,
please tell us a little more about yourself
