Dr Isabelle Meyer is the Executive Director of Dementia Training Australia (DTA). Funded by the Australian Government, DTA provides nationwide education and training on dementia care. Established in 2016, it brings together the expertise of five universities and Dementia Australia, coordinated by the University of Wollongong.
When we talk about dementia care, the conversation tends to focus on diagnosis, support services and quality of life. Medication safety rarely receives the same attention. It should. Recent research from the Australian Journal of Dementia Care (AJDC) has also pointed to this gap, highlighting the need to bring medication management into sharper focus.
More than 425,000 Australians are living with dementia, and most are also managing multiple chronic conditions alongside it. This often means complex medication regimens with varying doses and schedules, and side effects that require continuous monitoring. For families and carers, keeping on top of all this is increasingly overwhelming.
The consequences are showing up in the data. Over the past decade, annual hospitalisations linked to medication-related harm among people with dementia have risen by around 20 percent. Behind every one of those admissions is a person returning home from hospital, and often a carer trying to make sense of changes to a regimen that were never explained in practical terms. This is not only a clinical issue. It is a system design problem, and one we can fix.
The discharge moment is where risk peaks
Hospital discharge is one of the most critical points in the care journey. It is where medication changes are often made. New prescriptions are introduced, others are stopped, and doses and timings are adjusted. Yet carers are often given limited practical guidance on how to manage those changes once they are back home. Information about side effects, interactions, or medications that may worsen cognition is often unclear, incomplete, or missing altogether.
The effect is that clinical responsibility is transferred to families without the tools they need to carry it out safely. Medication reviews, including Home Medicines Reviews (HMRs) and Residential Medication Management Reviews (RMMRs), are one practical way to reduce this risk. They are typically initiated when a person is at increased risk of medication-related harm, including after hospital discharge, when managing complex regimens, multiple chronic conditions, cognitive or physical impairment, or when adverse drug reactions are suspected. Their role is to improve medication safety and optimise treatment in a way that supports the person’s overall care. (1)
Person-centred care has become the foundation of good dementia care in Australia, yet medication management too often falls outside that philosophy. A person-centred approach recognises that medication decisions are not only about treating conditions. They affect a person’s identity, autonomy and quality of life. This means involving people living with dementia and their carers in decisions about their treatment, rather than simply instructing them on what to do.
It also means giving people the opportunity to ask the questions that matter. Do they understand what each medication is for? Do they know what has changed and why? Do they feel confident managing those medications once they get home? If the answer to any of these questions is no, the system still has work to do.
Most interventions at hospital discharge focus on adherence, ensuring medications are taken correctly. Fewer support shared decision-making or build the confidence and skills of carers and patients. That is a missed opportunity. When people understand their medications, they are more likely to notice problems early, ask the right questions, and seek help before small issues escalate into hospital admissions. Not everyone will want to be deeply involved in these decisions, and that choice has to be respected. Everyone should be given the opportunity.
Co-designed solutions are already emerging
Practical solutions are taking shape. Recent Australian research led by Dr Mouna Sawan at the University of Sydney in the AJDC has produced co-designed educational resources, developed in close collaboration with people living with dementia and their carers. These include checklists, prompts and question guides to help structure conversations with healthcare professionals during hospital stays and at discharge.
The tools do not replace clinical advice. They help it land. They create a shared language among clinicians, patients and carers, so critical information is not only delivered but understood, and families have something to return to once they are home. These resources acknowledge that people living with dementia and their carers are not passive recipients of care. They are active partners in care.
None of this works without a workforce equipped to deliver it. Shared decision-making conversations about medications are genuinely difficult. They require clinical knowledge, communication skills, and the confidence to sit with uncertainty rather than default to instruction. Our experience at DTA is that these capabilities do not develop by accident. They require deliberate investment in education and training across the workforce, from hospital nurses and junior doctors to aged care workers, pharmacists and allied health professionals. Training alone will not solve medication safety in dementia care, but it is a necessary part of any serious response.
The way forward
Two-thirds of people living with dementia remain in the community. Medication safety is therefore not just a hospital or residential aged care issue. GPs, pharmacists, community nurses, allied health professionals, policymakers and service designers all have a role to play.
Relatively small changes can have a significant impact. Clearer communication. Better discharge processes. More accessible information for families. The dividends show up not only in reduced system costs but also in the daily lives of people navigating dementia.
Rising rates of medication-related harm are not inevitable. They signal that the system needs to evolve. We have the evidence and emerging solutions. What we need now is a collective commitment to act, embed person-centred approaches at every stage of medication management, and support the workforce that will deliver them.
(1) For more information, Dementia Training Australia offers medication management education, practical resources, workshops, and Medication Management Consultancy support to help health professionals and services improve medication safety and support person-centred dementia care. More information is available at dta.com.au/medication-management/
