MATCH-D Tool

MATCH-D Tool

Recommendations by stage

Consensus-based recommendations for medication management across dementia stages. Choose a stage to view its specific guidance.

Early Stage. Recommendations for people with mild cognitive impairment who retain the ability to self-care.

Early Stage: Mild cognitive impairment with a preserved ability to self-care and undertake activities of daily living.

Expert consensus is that these practices are recommended in the care of people with dementia

Treatment Goals

An important treatment goal for people living with dementia is to simplify the medication regimen.

Health professionals and the person living with dementia should discuss and document:

  • treatment goals
  • likely prognosis
  • writing an advance care directive to indicate their wishes for treatment in specific future scenarios
  • using a dose administration aid to support medication use

Health professionals and the carer or family of the person living with dementia should discuss and document:

  • treatment goals
  • likely prognosis
  • document wishes for treatment in specific future scenarios
Medication Side Effects

People living with dementia are:

  • at higher risk of side effects than cognitively-intact people
  • often unable to recognise side effects from their medications
  • often unable to report side effects from their medications
Principles of medication use

When prescribing for people living with dementia, health professionals should:

  • provide a current medication list that includes indications, administration instructions, and planned dates for review
  • regularly monitor for actual benefit of each medication
  • regularly monitor for actual side effects
  • start new medications at the lowest therapeutic dose
  • review doses frequently to see if a lower dose would be adequate
  • change only one medication at a time
  • assess impact of dementia on activities of daily living
Medication reviews

When reviewing medications use for people living with dementia, health professionals should check that each medication is:

  • underpinned by a current, valid indication
  • effective for that individual
  • consistent with individual’s care goals
  • documented with a time frame to review

A medication review should be triggered by:

  • a significant event (e.g. cardiovascular event, fall, fracture, hospital admission, residential care facility admission)
  • increasing frailty
  • resistance to taking medications
  • belief taking medications is a burden
  • writing a new prescription for the medication
  • decline in cognitive function
  • decline in ability to manage activities of daily living
  • regular use of five or more medications
Preventative medication

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

  • functionality as the most important factor
  • the potential benefits weighed against the actual harm
  • potential for side effects
  • actual side effects
  • the risks of polypharmacy
  • the administration burden
  • maximise quality of life rather than prolong survival
  • continue annual influenza vaccines indefinitely
Symptom management
  • trialled for withdrawal every three to six months if the symptoms are stable
  • reviewed regularly for efficacy
  • reviewed regularly for side effects
  • review doses frequently to see if symptoms can be adequately
  • maintained on a lower dose
  • maximised to alleviate distress
Psycho-active medications
  • use non-pharmacological strategies in preference to medications
  • benzodiazepines should not generally be used, but
  • short acting benzodiazepines can be useful for managing acute agitation provided use is monitored
  • antipsychotics can be useful when prescribed at a low dose for a limited period to alleviate distressing neuropsychiatric symptoms
  • antipsychotics should be considered if distressing behavioural
  • symptoms are not responsive to other management strategies
  • tricyclic antidepressants have a limited role, but
  • tricyclic antidepressants may be useful in managing refractory neuropathic pain
Medications to modify dementia progression
  • consider a trial of an anticholinesterase inhibitor
  • consider a trial of memantine
  • review dementia treatments with respect to desired benefits and actual side effects (i.e. memantine, anticholinesterases)
  • maximise cognitive function by reducing exposure to medications with sedative and anticholinergic properties

Expert consensus is that these practices are NOT recommended in the care of people with dementia

Treatment Goals

These treatment goals are important for people living with dementia:

  • the wishes and needs of family and carers should take priority over those of the person living with dementia
  • it is acceptable to conceal medications in food or drink if the person with dementia refuses them
Symptom Management

For people living with dementia, regular medications intended only to provide symptom relief should be continued indefinitely in people who are unable to reliably report symptom recurrence.

Preventative Medication

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

  • cease all medications that do not also provide tangible symptom relief
  • cease anti-platelet, anti-coagulants and anti-thrombotic agents
  • cease medications to manage osteoporosis
  • cease antihypertensive agents
Psycho-active medications
  • for managing behavioural and psychological symptoms of dementia, antipsychotics are never appropriate for behavioural management
  • for people living with dementia, long acting benzodiazepines can be useful, provided the risks are weighed against the benefits
Mid Stage. Recommendations for people with moderate cognitive impairment; physical function often preserved.

Mid-Stage Dementia: moderate cognitive impairment with physical function often preserved. People with mid-stage dementia may be living with support in the community or a low-care residential aged care setting.

Expert consensus is that these practices are recommended in the care of people with dementia

Treatment Goals

An important treatment goal for people living with dementia is to simplify the medication regimen.

Health professionals and the person living with dementia should discuss and document:

  • treatment goals
  • likely prognosis
  • writing an advance care directive to indicate their wishes for treatment in specific future scenarios
  • using a dose administration aid to support medication use

Health professionals and the carer or family of the person living with dementia should discuss and document:

  • treatment goals
  • likely prognosis
  • document wishes for treatment in specific future scenarios
Medication Side Effects

People living with dementia are:

  • at higher risk of side effects than cognitively-intact people
  • often unable to recognise side effects from their medications
  • often unable to report side effects from their medications
Principles of medication use

When prescribing for people living with dementia, health professionals should:

  • provide a current medication list that includes indications, administration instructions, and planned dates for review
  • regularly monitor for actual benefit of each medication
  • regularly monitor for actual side effects
  • start new medications at the lowest therapeutic dose
  • review doses frequently to see if a lower dose would be adequate
  • change only one medication at a time
  • assess impact of dementia on activities of daily living
Medication reviews

When reviewing medications use for people living with dementia, health professionals should check that each medication is:

  • underpinned by a current, valid indication
  • effective for that individual
  • consistent with individual’s care goals
  • documented with a time frame to review

A medication review should be triggered by:

  • a significant event (e.g. cardiovascular event, fall, fracture, hospital admission, residential care facility admission)
  • increasing frailty
  • resistance to taking medications
  • belief taking medications is a burden
  • writing a new prescription for the medication
  • decline in cognitive function
  • decline in ability to manage activities of daily living
  • regular use of five or more medications
Preventative medication

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

  • functionality as the most important factor
  • the potential benefits weighed against the actual harm
  • potential for side effects
  • actual side effects
  • the risks of polypharmacy
  • the administration burden
  • maximise quality of life rather than prolong survival
  • continue annual influenza vaccines indefinitely
  • use less stringent targets for blood pressure
  • use less stringent targets for blood glucose
  • cease lipid-lowering medications
  • cease medications that have a longer potential time to benefit than the person’s likely prognosis
Symptom management
  • trialled for withdrawal every three to six months if the symptoms are stable
  • reviewed regularly for efficacy
  • reviewed regularly for side effects
  • review doses frequently to see if symptoms can be adequately
  • maintained on a lower dose
  • maximised to alleviate distress
Psycho-active medications
  • use non-pharmacological strategies in preference to medications
  • benzodiazepines should not generally be used, but
  • short acting benzodiazepines can be useful for managing acute agitation provided use is monitored
  • antipsychotics can be useful when prescribed at a low dose for a limited period to alleviate distressing neuropsychiatric symptoms
  • antipsychotics should be considered if distressing behavioural
  • symptoms are not responsive to other management strategies
  • tricyclic antidepressants have a limited role, but
  • tricyclic antidepressants may be useful in managing refractory neuropathic pain
Medications to modify dementia progression
  • consider a trial of an anticholinesterase inhibitor
  • consider a trial of memantine
  • review dementia treatments with respect to desired benefits and actual side effects (i.e. memantine, anticholinesterases)
  • maximise cognitive function by reducing exposure to medications with sedative and anticholinergic properties

Expert consensus is that these practices are NOT recommended in the care of people with dementia

Treatment Goals

These treatment goals are important for people living with dementia:

  • the wishes and needs of family and carers should take priority over those of the person living with dementia
  • it is acceptable to conceal medications in food or drink if the person with dementia refuses them
Symptom Management

For people living with dementia, regular medications intended only to provide symptom relief should be continued indefinitely in people who are unable to reliably report symptom recurrence.

Preventative Medication

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

  • cease medications to manage osteoporosis
  • cease antihypertensive agents
Psycho-active medications
  • for managing behavioural and psychological symptoms of dementia, antipsychotics are never appropriate for behavioural management
  • for people living with dementia, long acting benzodiazepines can be useful, provided the risks are weighed against the benefits
Late Stage. Recommendations for people with severe cognitive impairment, declining function, approaching end-of-life.

Late-Stage Dementia: severe cognitive impairment and declining function (inability to recognise loved ones, unable to ambulate independently, incontinence of urine or faeces)

Expert consensus is that these practices are recommended in the care of people with dementia

Treatment Goals

An important treatment goal for people living with dementia is to simplify the medication regimen.

Health professionals and the person living with dementia should discuss and document:

  • likely prognosis
  • writing an advance care directive to indicate their wishes for treatment in specific future scenarios

Health professionals and the carer or family of the person living with dementia should discuss and document:

  • treatment goals
  • likely prognosis
  • document wishes for treatment in specific future scenarios
Medication Side Effects

People living with dementia are:

  • at higher risk of side effects than cognitively-intact people
  • often unable to recognise side effects from their medications
  • often unable to report side effects from their medications
Principles of medication use

When prescribing for people living with dementia, health professionals should:

  • provide a current medication list that includes indications, administration instructions, and planned dates for review
  • regularly monitor for actual benefit of each medication
  • regularly monitor for actual side effects
  • start new medications at the lowest therapeutic dose
  • review doses frequently to see if a lower dose would be adequate
  • change only one medication at a time
  • assess impact of dementia on activities of daily living
Medication reviews

When reviewing medications use for people living with dementia, health professionals should check that each medication is:

  • underpinned by a current, valid indication
  • effective for that individual
  • consistent with individual’s care goals
  • documented with a time frame to review

A medication review should be triggered by:

  • a significant event (e.g. cardiovascular event, fall, fracture, hospital admission, residential care facility admission)
  • increasing frailty
  • resistance to taking medications
  • belief taking medications is a burden
  • writing a new prescription for the medication
  • decline in cognitive function
  • decline in ability to manage activities of daily living
  • regular use of five or more medications
Preventative medication

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

  • functionality as the most important factor
  • the potential benefits weighed against the actual harm
  • potential for side effects
  • actual side effects
  • the risks of polypharmacy
  • the administration burden
  • maximise quality of life rather than prolong survival
  • use less stringent targets for blood glucose
  • only use diuretics for symptomatic management of heart failure
  • cease antihypertensive agents
  • cease lipid-lowering medications
  • cease medications to manage osteoporosis
  • cease anti-platelet, anti-coagulants and anti-thrombotic agents
  • cease all medications that do not also provide tangible symptom relief
  • cease medications that have a longer potential time to benefit than the person’s likely prognosis
Symptom management
  • trialled for withdrawal every three to six months if the symptoms are stable
  • reviewed regularly for efficacy
  • reviewed regularly for side effects
  • review doses frequently to see if symptoms can be adequately maintained on a lower dose
  • maximised to alleviate distress
Psycho-active medications
  • use non-pharmacological strategies in preference to medications
  • benzodiazepines should not generally be used, but short acting benzodiazepines can be useful for managing acute agitation provided use is monitored
  • antipsychotics can be useful when prescribed at a low dose for a limited period to alleviate distressing neuropsychiatric symptoms
  • antipsychotics should be considered if distressing behavioural symptoms are not responsive to other management strategies
  • tricyclic antidepressants have a limited role, but may be useful in managing refractory neuropathic pain
Medications to modify dementia progression
  • stop dementia treatments in late stage dementia (i.e. memantine, anticholinesterases)
  • maximise cognitive function by reducing exposure to medications with sedative and anticholinergic properties

Expert consensus is that these practices are NOT recommended in the care of people with dementia

Symptom Management

For people living with dementia, regular medications intended only to provide symptom relief should be continued indefinitely in people who are unable to reliably report symptom recurrence.

Psycho-active medications
  • for managing behavioural and psychological symptoms of dementia, antipsychotics are never appropriate for behavioural management
  • for people living with dementia, long acting benzodiazepines can be useful, provided the risks are weighed against the benefits
All Stages. Recommendations and not-recommended practices that apply across early, mid, and late stage dementia.

Expert consensus is that these practices are recommended in the care of people with dementia

Medication Side Effects

People living with dementia are:

  • at higher risk of side effects than cognitively-intact people
  • often unable to recognise side effects from their medications
  • often unable to report side effects from their medications
Principles of medication use

When prescribing for people living with dementia, health professionals should:

  • provide a current medication list that includes indications, administration instructions, and planned dates for review
  • regularly monitor for actual benefit of each medication
  • regularly monitor for actual side effects
  • start new medications at the lowest therapeutic dose
  • review doses frequently to see if a lower dose would be adequate
  • change only one medication at a time
  • assess impact of dementia on activities of daily living
Medication reviews

When reviewing medications use for people living with dementia, health professionals should check that each medication is:

  • underpinned by a current, valid indication
  • effective for that individual
  • consistent with individual’s care goals
  • documented with a time frame to review

A medication review should be triggered by:

  • a significant event (e.g. cardiovascular event, fall, fracture, hospital admission, residential care facility admission)
  • increasing frailty
  • resistance to taking medications
  • belief taking medications is a burden
  • writing a new prescription for the medication
  • decline in cognitive function
  • decline in ability to manage activities of daily living
  • regular use of five or more medications
Treatment Goals

An important treatment goal for people living with dementia is to simplify the medication regimen.

Health professionals and the carer or family of the person living with dementia should discuss and document:

  • treatment goals
  • likely prognosis
  • document wishes for treatment in specific future scenarios

Health professionals and the person living with dementia should discuss and document:

Early Stage

  • writing an advance care directive to indicate their wishes for treatment in specific future scenarios
  • using a dose administration aid to support medication use

Mid Stage

  • writing an advance care directive to indicate their wishes for treatment in specific future scenarios
  • using a dose administration aid to support medication use

Late Stage

  • writing an advance care directive to indicate their wishes for treatment in specific future scenarios
Preventative medication

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

All Stages

  • functionality as the most important factor
  • the potential benefits weighed against the actual harm
  • potential for side effects
  • actual side effects
  • the risks of polypharmacy
  • the administration burden
  • maximise quality of life rather than prolong survival

Early Stage

  • continue annual influenza vaccines indefinitely

Mid Stage

  • continue annual influenza vaccines indefinitely
  • use less stringent targets for blood pressure
  • use less stringent targets for blood glucose
  • cease lipid-lowering medications
  • cease medications that have a longer potential time to benefit than the person’s likely prognosis

Late Stage

  • use less stringent targets for blood glucose
  • only use diuretics for symptomatic management of heart failure
  • cease antihypertensive agents
  • cease lipid-lowering medications
  • cease medications to manage osteoporosis
  • cease anti-platelet, anti-coagulants and anti-thrombotic agents
  • cease all medications that do not also provide tangible symptom relief
  • cease medications that have a longer potential time to benefit than the person’s likely prognosis
Symptom management
  • trialled for withdrawal every three to six months if the symptoms are stable
  • reviewed regularly for efficacy
  • reviewed regularly for side effects
  • review doses frequently to see if symptoms can be adequately maintained on a lower dose
  • maximised to alleviate distress
Psycho-active medications
  • use non-pharmacological strategies in preference to medications
  • benzodiazepines should not generally be used, but
  • short acting benzodiazepines can be useful for managing acute agitation provided use is monitored
  • antipsychotics can be useful when prescribed at a low dose for a limited period to alleviate distressing neuropsychiatric symptoms
  • antipsychotics should be considered if distressing behavioural
  • symptoms are not responsive to other management strategies
  • tricyclic antidepressants have a limited role, but
  • tricyclic antidepressants may be useful in managing refractory neuropathic pain
Medications to modify dementia progression

Early Stage

  • consider a trial of an anticholinesterase inhibitor
  • consider a trial of memantine
  • review dementia treatments with respect to desired benefits and actual side effects (i.e. memantine, anticholinesterases)
  • maximise cognitive function by reducing exposure to medications with sedative and anticholinergic properties

Mid Stage

  • consider a trial of an anticholinesterase inhibitor
  • consider a trial of memantine
  • review dementia treatments with respect to desired benefits and actual side effects (i.e. memantine, anticholinesterases)
  • maximise cognitive function by reducing exposure to medications with sedative and anticholinergic properties

Late Stage

  • stop dementia treatments in late stage dementia (i.e. memantine, anticholinesterases)
  • maximise cognitive function by reducing exposure to medications with sedative and anticholinergic properties

Expert consensus is that these practices are NOT recommended in the care of people with dementia

Treatment Goals

These treatment goals are important for people living with dementia:

Early Stage

  • the wishes and needs of family and carers should take priority over those of the person living with dementia
  • it is acceptable to conceal medications in food or drink if the person with dementia refuses them

Mid Stage

  • the wishes and needs of family and carers should take priority over those of the person living with dementia
  • it is acceptable to conceal medications in food or drink if the person with dementia refuses them

Late Stage

  • No specific not-recommended items at this stage
Preventative Medications

When prescribing medications intended to modify the risk of a future event for a person living with dementia, health professionals should consider:

Early Stage

  • cease all medications that do not also provide tangible symptom relief
  • cease anti-platelet, anti-coagulants and anti-thrombotic agents
  • cease medications to manage osteoporosis
  • cease antihypertensive agents

Mid Stage

  • cease medications to manage osteoporosis
  • cease antihypertensive agents

Late Stage

No NOT-recommended preventative medications specific to late stage.

Symptom Management

For people living with dementia, regular medications intended only to provide symptom relief should be continued indefinitely in people who are unable to reliably report symptom recurrence.

Psycho-active medications
  • for managing behavioural and psychological symptoms of dementia, antipsychotics are never appropriate for behavioural management
  • for people living with dementia, long acting benzodiazepines can be useful, provided the risks are weighed against the benefits