Psychotropic drugs are used too often to treat dementia patients in aged care "because when all you have is a hammer, every problem looks like a nail", the royal commission examining the sector has heard.
Geriatrician Edward Strivens says about 80 per cent of patients with dementia are currently on at least one form of psychotropic medication, such as antidepressants or sedatives.
But he says only about 10 per cent would see real improvement while the possible side effects could include falls and deaths from strokes.
"They do work, for want of a better term, however, the side effects will often outweigh the possible benefits," Professor Strivens told the commission on Wednesday.
"They are a last resort but too often we see them used as a first resort.
"The use of medication should never be a substitute for good quality care."
Prof Strivens said it was often possible to treat dementia patients with non-drug strategies by looking at the cause of particular issues.
In the case of residents presenting with agitation or physical outbursts, he said drugs were far too often used as the first option.
That was in part because "when all you have is a hammer, every problem looks like a nail", he said.
Prof Strivens said the use of psychotropic drugs should follow the principles of "start low, go slow and review regularly".
"It's about using the smallest possible dose for the briefest possible time and making sure it works," he said.
"And if it doesn't work you don't just keep on increasing or adding different agents, you look at withdrawing and trying other things.
"This is often more time consuming and more labour intensive but it's what we need to do."
The royal commission was also told of problems retaining nursing staff in aged care facilities because of lower pay rates and increasingly high workloads.
It heard that staff ratios of one nurse to 60 residents was not the worst to be found across the industry.
"What we hear most often from our members is the increasing pressure they're experiencing," Australian Nursing and Midwifery Federation national secretary Annie Butler said.
"Many of them across the country describe their workloads now as unsafe, they're untenable."
She said nurses were finding it increasingly difficult to meet both their professional obligations and the expectations of employers.
Deborah Parker, from the Australian College of Nursing, said the complexity of patient needs in aged care was also going up as the number of nurses within the system was going down.
The royal commission is investigating both the quality and safety of residential and home care across the country and will continue to sit in Adelaide next week.
