Management Monday: Dementia Red Flags — When to Call the Nurse

Dementia rarely changes in a straight line. For families and support workers, the hardest part is knowing which changes are “just part of the condition” and which are a signal that something clinical is going on. This Management Monday, we walk through the red flags that should prompt a call to a Registered Nurse.

Why sudden change matters

Dementia is progressive, but it is usually gradual. When decline is sudden — over hours or days rather than months — it is almost never the dementia itself. A rapid change in thinking, alertness or behaviour is one of the clearest signals that a treatable problem is hiding underneath.

A sudden worsening of confusion in a person with dementia is a symptom, not a stage. Treat it as a reason to investigate, not something to wait out.

The red flags

1. A sudden spike in confusion (delirium)

New agitation, drowsiness that comes and goes, or confusion that is noticeably worse than the person’s baseline often points to delirium. Common triggers include:

• Urinary tract or chest infections
• Dehydration or constipation
• Pain that the person can no longer describe
• A new medication or a missed dose

Delirium is a medical event. A nurse can assess, screen for infection, and coordinate with the GP before it escalates to hospital.

2. Not eating or drinking

A day or more of refusing food and fluids risks dehydration and rapid decline. It can also be the first sign of pain, mouth problems, or difficulty swallowing that needs clinical review.

3. New or worsening pain

People with dementia often can’t say “it hurts.” Watch for grimacing, guarding a body part, resistance to movement, or a change in how they hold themselves. Unmanaged pain is one of the most common — and most fixable — causes of “difficult” behaviour.

4. Falls, or a near-miss

One fall is a reason to review the environment and the person’s medications. Any fall with a head knock, or a person who can’t be roused normally afterwards, is an urgent call.

5. Skin and wound changes

Redness that doesn’t fade, a new pressure area, or a wound that looks worse warrants a clinical eye before it becomes serious.

What a nurse adds

A Registered Nurse can complete a clinical assessment in the home, screen for the common reversible causes above, adjust the care plan, and liaise with the GP and pharmacy — often keeping the person safe at home and out of an emergency department.

If you’re a Support Coordinator or family member and something feels different, trust that instinct. Get in touch and we’ll organise a review.