Explain BPSD management and antipsychotic risks to a family carer — CASC station

Open. Acknowledge how frightening the hit and the "long-term sedative" suggestion are. Agenda: safety, causes, non-drug plan, medicines only if needed. [1]

Explain BPSD. Behavioural and psychological symptoms of dementia are common. They are usually driven by brain changes plus triggers — pain, constipation, infection, fear during personal care, noise, unfamiliar approach — not simple "naughtiness." [1]

Plan without rushing to drugs. We will map what happens at shower time, check for pain (arthritis), constipation, urine infection and delirium features, and change the care approach (warmth, two staff, slow steps, music). Treating pain can reduce behavioural disturbance. Carer/staff skills matter. [3][4]

Medicines. If he remains at high risk of harm after those steps, a short trial of a very low-dose antipsychotic (e.g. risperidone starting around 0.25–0.5 mg) might be considered for severe aggression/psychosis — not for wandering or mild irritability. Benefits are modest. Important harms: higher risk of death and stroke/cerebrovascular events, plus sleepiness and falls. This would not be a lifelong automatic tablet; we review soon and aim to stop when safe. [2][5]

Close. Summarise, check teach-back, offer written information, crisis contacts for staff injury/escalation, and a review date. Invite questions about consent/substitute decision-making. [1]