“She’s suddenly confused and agitated — can you prescribe something to settle her?”

Acute, fluctuating confusion and agitation over hours–days on a background of dementia — with hallucinations and sleep-wake disturbance — is DELIRIUM, a sign of underlying physical illness, NOT a behaviour to be sedated on request. The task is to find and treat the cause(s): a systematic screen (infection — UTI/chest; constipation; dehydration/reduced intake; pain/retention; and crucially a NEW MEDICATION, often anticholinergic/sedative/opioid — "PINCH ME"), with assessment/examination, urine, obs, bloods and a medication review. Non-pharmacological measures come FIRST (treat the precipitant, reorientation, familiar faces, hydration, sleep hygiene, glasses/hearing aids, pain relief, mobilise, treat constipation); antipsychotics/sedatives carry real harms in delirium/dementia (falls, stroke, increased mortality, worsening delirium) and are a last resort for severe distress/risk only, at the lowest dose with review. The examinable hidden agenda is a stretched, overwhelmed care home seeking chemical restraint to manage a staffing problem; support the staff with empathy while NOT colluding — redirect to the cause and non-drug measures, assess in person, and escalate/admit if she is septic or unsafe.