Recognising concerns and responding appropriately

Pharmacy teams should not try to diagnose dementia. They should, however, notice patterns that suggest worsening cognition, increased medicine risk, or the need for clinical review.

What pharmacy teams may notice

• Repeated questions or repeated purchases: the person may ask the same thing several times in one visit or return shortly after for the same medicine.
• Unexpected medicines problems: early requests, missed collections, a build-up of unused medicines, confusion about what a medicine is for, or difficulty following a once-familiar routine.
• Communication and orientation problems: difficulty following simple explanations, becoming disoriented in the pharmacy, or seeming unsure why they are there.
• Changes noticed by carers or delivery staff: relatives, paid carers, or drivers may report increasing confusion, signs of self-neglect, missed doses, or difficulty managing at home.
• Changes in behaviour or function: agitation, apathy, suspiciousness, poor personal care, or problems with money, shopping and everyday tasks may be more evident during pharmacy contact.

Gradual change and sudden change are not the same

Dementia usually develops gradually. Sudden confusion, however, should not be assumed to be chronic decline. Delirium, infection, dehydration, pain, constipation, low blood sugar, medicine side effects or an acute illness may require urgent attention.

In the pharmacy, a regular patient who is much more confused than usual, drowsy, hallucinating, newly agitated, or suddenly unable to manage may need prompt escalation rather than routine reassurance.

Pharmacy teams do not diagnose dementia, but they should recognise when someone is struggling more than before and treat sudden cognitive change as potentially urgent.