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GPs & clinicians

“I am a GP or clinician”

The clinical pages assume you do not need dementia explained, and get to the parts that change management: what the assessment must exclude, what the psychotropic evidence actually shows, what the restrictive practice rules require of you personally, and where the emerging evidence is genuinely interesting rather than merely promoted.

Clinical shortcuts

The first ten minutes of a behaviour call

The prescription written over the phone at 7pm is the one still on the chart two years later. This sequence costs little and prevents most of that.

  1. Establish the time course. Hours to days is delirium until proven otherwise. Weeks to months is progression, or an unmet need that has gone unaddressed.

  2. Ask what has changed. Medication, infection, bowels, bladder, hydration, staffing, environment, roommate, recent admission.

  3. Ask what has been tried and for how long. If the answer is nothing, or “we tried but she wouldn’t settle”, the intervention needed is a plan and not a drug.

  4. Ask for a formal pain score. PAINAD or Abbey. A stepwise analgesic protocol reduced agitation by 17% in a cluster-randomised trial, an effect comparable to or better than antipsychotics with none of the harm 49.

  5. Attend and examine. Chest, abdomen, bladder, skin, joints, ears. Most reversible causes are found on examination, not on the phone.

  6. If prescribing, set the exit condition now. Target symptom, review date within days, and the circumstances under which it stops. Document alternatives tried and the consent conversation before, not after.

New resident: the admission review that pays for itself

Half an hour at admission prevents a great deal downstream.

  • Verify the diagnosis and name the subtype. “Dementia” on a problem list tells the after-hours locum nothing about antipsychotic sensitivity or expected trajectory. Transfer documentation is frequently wrong or unsubstantiated.

  • Confirm the reversibles were excluded. B12, folate, TFTs, calcium, glucose, and a delirium screen. A surprising proportion of dementia labels were applied on day three of an acute admission.

  • Calculate anticholinergic burden formally. Nearly one in five Australian patients with dementia still carries a mean daily ACB score of 3 or more 62. Oxybutynin prescribed alongside donepezil remains a common finding.

  • Audit every psychotropic against an indication and a review date. Note which were started in hospital and simply continued.

  • Reconsider preventive medicines against prognosis. Statins, bisphosphonates and tight glycaemic or blood pressure targets have time-to-benefit measured in years. Hypoglycaemia and postural hypotension are immediate.

  • Establish goals of care and document them. Before the first deterioration, not during it.

  • Chart anticipatory medicines. Subcutaneous analgesia, antiemetic, anxiolytic and antisecretory, so a symptom at 2am does not become an ambulance.

Deprescribing sequence

Highest yield first. Document the reasoning — undocumented deprescribing reads as neglect in an audit and as abandonment to a family.

  1. Anticholinergics. Oxybutynin, amitriptyline, promethazine first. Cochrane found insufficient randomised evidence that reduction improves cognition 63, but the delirium, falls, retention and constipation harms are not in doubt.

  2. Benzodiazepines and Z-drugs. Taper. Abrupt cessation causes rebound agitation that gets misread as treatment failure.

  3. Antipsychotics without a current indication. Most residents on long-term antipsychotics for behaviour withdraw without symptom return 66.

  4. Preventive medicines misaligned with prognosis. As above.

  5. Cognitive medicines in advanced disease. Where the person no longer recognises family and requires full assistance, the case for continuing is weak. Taper and monitor — deterioration on withdrawal is useful information, not a failure.

Triggers to revisit goals of care

Reviewing only at admission is the commonest failure. Each of these is a natural prompt.

  • Any hospital transfer. Particularly a second or third within a year.

  • Recurrent infection despite treatment. Especially aspiration pneumonia.

  • A new or unresolving swallowing problem. The point at which tube feeding gets raised, and the point to have the conversation properly 767778.

  • Unintentional weight loss. A marker of the terminal phase in advanced dementia.

  • A new pressure injury. Or one that is not healing.

  • Loss of independent mobility. A reliable inflection point in trajectory.

Your reading pathway

The same library everyone else reads, sequenced for what you actually need from it and why.

  1. 1 Diagnosis and assessment 9 min read The workup, what must be excluded before accepting a label, and where blood biomarkers currently sit in Australian practice.
  2. 2 Medicines in dementia 13 min read Cognitive medicines and PBS criteria, quantified antipsychotic harms, chemical restraint obligations, anticholinergic burden and deprescribing.
  3. 3 Changed behaviours 11 min read The non-pharmacological evidence base, so you can be specific about what to ask the facility to try rather than gesturing at it.
  4. 4 Emerging evidence: a clinical appraisal 20 min read Anti-amyloid access in Australia, the EVOKE result, biomarkers, low-dose lithium on its full evidence base, and the adjuncts patients raise.
  5. 5 Advanced dementia and end-of-life care 11 min read Prognostication, tube feeding, antibiotics at the end of life, and anticipatory prescribing.
  6. 6 Risk reduction and brain health 12 min read For the worried-well consultation and the adult children asking what they should be doing themselves.

Browse every topic instead →

Sources cited on this page

  1. 49 Husebo BS, et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ. 2011;343:d4065.
  2. 54 Australian Government Department of Health, Disability and Ageing. Restrictive practices in aged care — a last resort. View source
  3. 62 Bezabhe WM, et al. Trends in anticholinergic drug exposure and associated risk factors in older Australian patients with dementia. J Psychiatr Res. 2026. (19.2% of Australian patients with dementia had a mean daily ACB score ≥3 in 2020.)
  4. 63 Taylor-Rowan M, et al. Anticholinergic deprescribing interventions for reducing risk of cognitive decline or dementia in older adults. Cochrane Database Syst Rev. 2022.
  5. 66 Australian Prescriber. Supporting the appropriate use of psychotropic medicines in aged and disability care. View source
  6. 76 Davies N, et al. Enteral tube feeding for people with severe dementia. Cochrane Database Syst Rev. 2021. (No randomised trials exist; 14 non-randomised studies, all at high or very high risk of bias from confounding.)
  7. 77 Teno JM, et al. Feeding tubes and the prevention or healing of pressure ulcers. Arch Intern Med. 2012. (Propensity-matched nursing home cohort: PEG associated with 2.27 times the odds of a new pressure ulcer and reduced healing of existing ulcers.)
  8. 78 Lee YF, et al. The efficacy and safety of tube feeding in advanced dementia patients: a systematic review and meta-analysis. J Am Med Dir Assoc. 2020. (12 studies, 5,666 patients; mortality OR 1.79, 95% CI 1.04–3.07.)

See every source cited across the dementia section →

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Living with dementia Family & carers Nurses & care workers Facility leadership

General information only, reflecting the interpretation of Umbrella Aged Care’s GPs of the published evidence as at September 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

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