New or worsening agitation in a person with dementia is usually driven by something that can be found. Pain that the patient can no longer report, constipation, urinary retention, an infection, a new drug with anticholinergic load, poor sleep, hearing aids left out, or simply a change of room or carer will each present as behaviour rather than as a complaint.
So work the list before reaching for a prescription. Examine the abdomen and bladder, check the bowel record, look for a fracture in anyone who has fallen, review every drug added in the last fortnight, and ask the carer what changed in the week before the behaviour did. A specific, recent trigger is present far more often than the diagnosis alone would suggest.
Where a drug is genuinely needed, name the target behaviour, set a review date, and record what you expect to change. Sedation is the easiest outcome to achieve and the least useful one to have achieved.
- Examine for pain, constipation and urinary retention before prescribing anything.
- Review drugs added in the past two weeks, especially those with anticholinergic burden.
- Ask the carer what changed — room, staff, routine, hearing aid, spectacles.
- Name the target behaviour and a review date if you do prescribe.
- Do not accept sedation as evidence that the treatment worked.
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