Psychotropic drugs, including antidepressants and sedatives, are used too often as the first resort to deal with dementia patients in residential care, the royal commission into aged care has heard.
Geriatrician Edward Strivens says about 80 per cent of patients with dementia are currently on at least one form of psychotropic medication.
But he says only about 10 per cent would see real improvement and possible side effects include falls and deaths from strokes.
"They do work, for want of a better term, however, the side effects will often outweigh the possible benefits," Professor Strivens told the commission on Wednesday.
"They are a last resort but too often we see them used as a first resort.
"The use of medication should never be a substitute for good quality care."
Professor Strivens said it was often possible to treat dementia patients with non-drug strategies by looking at why they had particular issues and considering their whole life story.
In the case of residents presenting with agitation or physical outbursts, he said drugs were far too often used as the first option, instead of looking at the reasons prompting the behaviour.
That was in part because "when all you have is a hammer, every problem looks like a nail".
Professor Strivens said the use of psychotropic drugs should follow the principles of "start low, go slow and review regularly".
"It's about using the smallest possible dose for the briefest possible time and making sure it works," he said.
"And if it doesn't work you don't just keep on increasing or adding different agents, you look at withdrawing and trying other things.
"This is often more time consuming and more labour intensive but it's what we need to do."
The royal commission is investigating both the quality and safety of both residential and home care across the country.
It will sit for another five days in Adelaide next week but also take evidence at further hearings planned for interstate capitals as well as regional centres.
It has already received 800 public submissions and responses from about 900 of Australia's 2000 approved aged care providers.
Australian Associated Press
