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Nurses & care workers

“I am a nurse or care worker”

You are the person who notices first, and the quality of what you hand the doctor largely determines what they can do about it. This page is the shift-floor version — what to try, what to record, what to say, and what cannot wait until the next visit.

On-shift toolkit

The five-minute check before you call the GP

Most escalations for behaviour have a cause you can find on the floor. Working through this first is not a delay — it is the assessment the doctor will ask you for anyway, and it frequently solves the problem outright.

  1. Pain. Use PAINAD or Abbey rather than asking. Look for guarding, grimacing on transfer, resisting personal care on one side, new reluctance to weight-bear. Consider whether regular paracetamol has actually been trialled — in the Norwegian trial a stepwise analgesic protocol cut agitation by 17%, and paracetamol alone accounted for much of it 4983.

  2. Bowels and bladder. When did they last open their bowels? Is the bladder palpable? Constipation and retention are two of the most common and most missed causes of sudden agitation.

  3. Infection. Urinary, chest, skin. Often without fever in frail residents. New confusion is the presentation.

  4. Sensory aids. Hearing aid in and working? Batteries? Glasses on and clean? Wax? Cheap, fast, and repeatedly the whole answer.

  5. Basic needs and environment. Hungry, thirsty, needing the toilet, too hot, too cold. Noise, television, crowding, shift handover, a new roommate, a change of staff.

  6. Medication. Anything new or changed in the past week — including antibiotics, steroids, opioids and anticholinergics. Any dose missed?

De-escalation that works on shift

Non-pharmacological approaches outperformed drugs for aggression and agitation in a network meta-analysis of 163 randomised trials 48. These are the versions that survive a real shift.

  • Approach from the front, at eye level. Say who you are and what you are about to do, every time. Being approached from behind or above is frightening.

  • One carer, not three. Two people in the doorway reads as a threat. Bring the second person in only if you need to.

  • Slow down and lower your voice. When language stops carrying meaning, tone carries all of it. Speed reads as anger.

  • Offer a choice, not an instruction. “Shower now or after breakfast?” succeeds where “time for your shower” fails.

  • Leave and come back. Almost nothing in personal care has to happen in the next ten minutes. Withdrawing and returning in twenty is a legitimate clinical intervention, not a failure.

  • Answer the feeling, not the facts. If she is looking for her mother, she is frightened or lost. “You’re worried about her” works; “your mother died in 1982” does not, and creates fresh grief each time.

  • Use what the life story tells you. Their music, their era, their language, their team, their work. Personally tailored interventions rank among the most effective for agitation 84.

  • Write down what worked. And what preceded the episode. That is the ABC record, and it is what turns one good shift into a care plan.

Making the call count

A GP can act on a structured handover and cannot act on “she’s been agitated again”. Four lines is enough.

  1. Situation. Who, their dementia subtype if known, and what has changed in one sentence. “Mrs K, Lewy body dementia, new drowsiness and unsteadiness since yesterday.”

  2. Background. Baseline function two weeks ago, relevant conditions, and any medication change in the last week.

  3. Assessment. Observations, PAINAD or Abbey score, bowels, bladder scan, hydration, and what you have already tried and for how long.

  4. Request. Say what you want. A review today, a phone opinion, an analgesic order, a urine dip, or a discussion with the family. An unstated request usually goes unmet.

Why this matters more than it may feel like at 6pm

Antipsychotics in dementia carry roughly double the risk of pneumonia, and increased risks of stroke, fracture, venous thromboembolism, acute kidney injury and death — with harms clustering in the first four weeks of treatment 5053. A great many of those prescriptions begin with a phone call at the end of a hard shift.

The five minutes spent checking bowels, pain, bladder and hearing aids before making that call is one of the more valuable things done for a resident on any given shift.

Your reading pathway

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

  1. 1 Changed behaviours 11 min read The core page for your work. Unmet needs, the ABC method, and what the trial evidence says actually reduces agitation.
  2. 2 Understanding dementia 8 min read Ten minutes on the subtypes. Knowing a resident has Lewy body disease changes what you escalate and how urgently.
  3. 3 Medicines in dementia 13 min read What the psychotropics on your chart actually do, the harms, and the restrictive practice rules that bind the facility as well as the prescriber.
  4. 4 Advanced dementia and end-of-life care 11 min read Recognising the terminal phase, comfort care, and why careful hand feeding is preferred to a feeding tube.
  5. 5 Living well, and supporting families 10 min read For the conversations with families — what to say, and where to send them for support.

Browse every topic instead →

Sources cited on this page

  1. 48 Watt JA, et al. Comparative efficacy of interventions for aggressive and agitated behaviors in dementia: a systematic review and network meta-analysis. Ann Intern Med. 2019;171:633–42.
  2. 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.
  3. 50 Mok PLH, et al. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ. 2024;385:e076268.
  4. 53 Le HT, et al. Multiple adverse outcomes associated with risperidone in people with dementia: an individual participant data meta-analysis. CNS Drugs. 2026.
  5. 54 Australian Government Department of Health, Disability and Ageing. Restrictive practices in aged care — a last resort. View source
  6. 64 Australian Commission on Safety and Quality in Health Care. Delirium Clinical Care Standard. View source
  7. 83 Sandvik R, et al. Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: a cluster randomized trial. Eur J Pain. 2014. (Benefit was apparent in the paracetamol group from week 2.)
  8. 84 Leng M, et al. Comparative efficacy of non-pharmacological interventions on agitation in people with dementia: a systematic review and Bayesian network meta-analysis. Int J Nurs Stud. 2019. (65 randomised trials; massage therapy, animal-assisted intervention and personally tailored intervention ranked highest.)

See every source cited across the dementia section →

Reading on behalf of someone else?

Living with dementia Family & carers GPs & clinicians 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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