Psychotropic drugs are used too often to treat patients with dementia for adult care, "because when everything you have is a hammer, every problem seems like a nail," says the royal committee that examines the sector.
Geriatric Edward Strivens says that about 80% of dementia patients currently have at least one form of psychotropic medication, such as antidepressants or sedatives.
But he says that only about 10% will see real improvement, while possible side effects can include strokes and stroke deaths.
"They work without having a better term, but the side effects will often outweigh the potential benefits," Professor Strivens told the committee Wednesday.
"They are the last resort, but we often see them as the first resort.
"The use of medicines should never be a substitute for good quality care."
Prof. Strivens said that it is often possible to treat patients with dementia with non-drug-related strategies by addressing the cause of certain problems.
In the case of residents presenting agitation or physical outbursts, he said that drugs are too often used as the first option.
This was partly because "when all you have is a hammer, every problem looks like a nail," he said.
Prof. Strivens said that the use of psychotropic drugs should follow the principles of "start low, slow and regular".
"It's about using the slightest possible dose for the shortest possible time and making sure it works," he said.
"And if it does not work, not just keep growing or adding different agents, but watching to download and try other things.
"This often takes more time and is more labor-intensive, but that's what we have to do."
The Royal Commission also spoke about problems related to the retention of medical staff in old care, due to lower wages and increased workload.
He has heard that the ratio of a nursing staff to 60 residents is not the worst that can be found in the industry.
"What we most often hear from our members is the growing pressure they are experiencing," said Annie Butler, National Secretary of the Federation of Nursing and Midwifery in Australia.
"Many of them across the country describe their current load as dangerous, they are untenable."
She said that nurses are increasingly struggling with their professional duties and employers' expectations.
Deborah Parker of the Australian Nursing College said that the complexity of patients' needs in elderly care also increases with the reduction in the number of nurses in the system.
The Royal Commission is investigating both the quality and safety of domestic and home care throughout the country and will continue to sit in Adelaide next week.
Australian Associated Press