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Dementia and delirium assessment / management

What is it

Specific assessment and management options for dementia and delirium patients. There are various models in place across the state to deliver services and support for patients with dementia and delirium. These models work across primary, acute, subacute and community settings. 

How it works

These models operate across two spectra:

  1. They provide education to clinical and non-clinical staff on delivering care to older persons with dementia/delirium.
  2. They also work directly with patients to facilitate continuity of care by linking older patients with appropriate follow-up care and support, and providing specialised dementia and delirium care. Some models focus on providing in-reach services to the Emergency Department from the community to provide continuity of care for patients who may otherwise be confused by their care journey.


These models are predominately resourced by Clinical Nurse Consultants (CNCs) in both acute and community settings (some of which service entire Local Health Districts on 1 Full Time Equivalent). Other hospitals (such as Wagga Wagga Base) use Assistants in Nursing (AINs) to deliver support services to the dementia and delirium cohort. This has been a particularly effective model as there have been enough AINs to provide ‘activities of daily living’ support to patients.

Success factors

  • Involvement of the carer and family in care and understanding what triggers behaviours
  • Dedicated staff/champions experienced in working with patients with dementia and/or delirium to educate and support other staff on assessment and management plans
  • Confirmed protocols and process on how to manage dementia and delirium patients

Models in operation

  • TOP5 Program (Wagga, Dubbo, Westmead, Kyogle)
  • Assistance in Nursing Dementia/Delirium (Wagga)
  • Acute and Community CNC Dementia/Delirium (across all sites visited)
  • Dementia Behaviour Management Advisory Service (DBMAS) in-reach to ED (Nepean and Taree)
  • Hornsby Telehealth Dementia Clinic