Feb 20, 2023

New advice service to support GPs treating complex dementia patients

20_02_23 dementia GP advice HC

General practitioners (GPs) who regularly consult in aged care facilities will have access to a new advice service to help them manage the clinical needs of older people with dementia complicated by behavioural and psychological symptoms.

Dementia Support Australia, a service led by aged care provider HammondCare, has launched the GP Advice Service offering direct email access to psychogeriatricians and geriatricians when treating older patients with Behaviours and Psychological Symptoms of Dementia (BPSD).

BPSD may include psychosis, agitation and aggression, depression, anxiety, apathy, impulsivity, pacing, vocalisations, appetite and eating changes, sleep disturbances, distress during personal care and wayfinding difficulties.

The GP Advice Service aims to guide practitioners on treatment strategies based on their patients’ clinical information such as their presentation and history.

The Royal Commission into Aged Care Quality and Safety identified the overuse of psychotropic medication in aged care residents with BPSD as a significant issue and highlighted the minimal training that doctors receive in management of these challenges.

The advice service’s debut follows the end of the public consultation period for the draft National Dementia Action Plan last month.

The plan is a ten year initiative between State and Federal Governments to create a coordinated approach to risk reduction for people living with dementia, a system of early diagnosis and better support for carers.

While experts in the sector have praised the Government’s decision to develop the action plan, there are concerns this draft fails to address the segregation and detention of people living in aged care, particularly those in secure dementia units.

‘We believe [the plan] will raise awareness of, and provide appropriate services and supports to, people living with dementia as well as their carers and families… But we are concerned that the current draft makes no mention of the human rights of people living with dementia,” said Older Persons Advocacy Network’s (OPAN) Chief Executive Officer (CEO), Craig Gear. 

“As we note in our recent submission paper, people living with dementia are also frequently denied their rights in community and health care settings, and by family or appointed Guardians or Attorneys.”

Moving away from psychotropic medication use

Up to 95% of older people living with dementia will experience forms of behavioural or psychological symptoms and many of them will be wrongly prescribed psychotropic medications or chemically and physically restrained.

While BPSD may be directly related to the disease, in many instances, changes in behaviour can result from unmet needs, pain or changing circumstances.

DSA Head of Clinical Services, Associate Professor Steve Macfarlane, said it was now generally accepted that psychotropic medications have a limited role in the management of BPSD.

“Nonpharmacological strategies should be an important part in the management of dementia complicated by BPSD and in fact be the mainstay of treatment in most patients,” he explained.

“We want to do all we can to support GPs to consider alternatives to these medications.”

Some of the adverse outcomes associated with psychotropic medications in dementia include increased risks of death, falls, weight gain, hypertension and diabetes, a restriction on the patient’s ability to swallow and an increase in the risks of aspiration, pneumonia, and other respiratory conditions.

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