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Atrial Fibrillation Anticoagulation — UKMLA MCQ

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An 82-year-old care-home resident with moderate Alzheimer's disease has become verbally aggressive during morning personal care over the past week. She is calm at other times, has not threatened anyone and appears to guard her left hip when being dressed. Staff request an antipsychotic. What is the most appropriate initial management?

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Correct answer: D — Assess for pain, delirium and environmental triggers before altering medication

The behaviour is context-specific and may communicate pain or distress rather than represent a primary indication for psychotropic medication. NICE recommends a structured assessment before either non-pharmacological or pharmacological treatment, including investigation of pain, delirium, unmet needs and environmental causes. Care practices and triggers should then be modified, with appropriate treatment of any identified cause. Antipsychotics are reserved for a risk of harm or agitation, hallucinations or delusions causing severe distress, and must be used at the lowest effective dose for the shortest possible time. Valproate is not recommended for dementia-related aggression.

Reference: NICE NG97, Dementia: assessment, management and support, recommendations 1.7.1–1.7.10 and 1.8.3–1.8.5: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations/