Skip to main content Accessibility help
×
Home
Hostname: page-component-99c86f546-cxxrm Total loading time: 0.172 Render date: 2021-12-01T22:44:39.224Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Challenging behaviour in dementia care: a novel framework for translating knowledge to practice

Published online by Cambridge University Press:  12 October 2020

Ian A. James*
Affiliation:
Newcastle Department of Older Adult Clinical Psychology, Akenside Offices, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Westgate Road, Newcastle upon TyneNE4 6BE, UK
Katharina Reichelt
Affiliation:
Newcastle Department of Older Adult Clinical Psychology, Akenside Offices, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Westgate Road, Newcastle upon TyneNE4 6BE, UK
Esme Moniz-Cook
Affiliation:
Faculty of Health Sciences, Dearne Building Room 109, University of Hull, HullHU6 7RX, UK
Katy Lee
Affiliation:
Intensive Support Service for Older People, Surrey and Borders Partnership NHS Foundation Trust, UK
*
*Corresponding author. Email: Ianandrew.james@cntw.nhs.uk

Abstract

This article provides guidance on the management of challenging behaviours (CBs) in dementia care, and introduces concepts from positive behavioural support not usually applied to dementia. While the use of formulations has received a lot of attention in recent years, the mechanisms of how to apply the formulation-led interventions requires more consideration. In order to assist caregivers to deliver effective interventions we need to have a better understanding of the CBs we are attempting to manage, and also produce management strategies with clearer goals. Ideally we would also want caregivers to be able to describe the skills they employ in a coherent manner in order to facilitate self-reflection and to be able to pass on their skills to junior colleagues. This paper attempts to fulfil these needs by integrating two new models with philosophies already used in dementia care. In terms of new concepts, the first is the Arousal Cycle, which gives caregivers an awareness of the five phases of a typical CB (wellbeing, trigger, escalation, CB, and recovery phase). In relation to the second, the Traffic Light analogy examines CBs in terms of four management stages: primary prevention, secondary prevention, reactive strategies, and calming strategies. It is proposed that we distinguish between these stages when composing our formulations and care plans, and thereby produce better targeted interventions. By the end of the paper the reader will have been presented with material integrating concepts from the fields of dementia and intellectual impairment, and been introduced to new ways of managing CBs.

Key learning aims

After reading this article people will:

  1. (1) Be provided with more specific guidance regarding the management of challenging behaviour (CB) in dementia; such guidance was not provided by the update of the NICE guidelines for dementia (2018).

  2. (2) Appreciate that the unmet needs perspective helps us both to understand why CB occur and to select appropriate management strategies.

  3. (3) Have an increased awareness and knowledge of new models from outside of the field of dementia. For example, through the use of the ‘arousal cycle’ people can recognise that a CB should more realistically be seen as having different phases (beginning, middle, end) rather than being perceived as a single action.

  4. (4) Be introduced to the traffic light conceptualisation which provides a useful way for guiding management strategies.

  5. (5) Be aware of when best to use resource-intensive formulations.

  6. (6) Recognise that in addition to conceptualising the person in relation to the CB, it is helpful to conceptualise the structural elements of the behaviour too.

  7. (7) Appreciate the need to help caregivers to recognise their existing skills, and to give carers the means to be able to articulate these abilities. Many care home staff currently work intuitively in the way they deliver care; as such we think they require practical frameworks and protocols to help them better elucidate what they do.

Type
Empirically Grounded Clinical Guidance Paper
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballard, C., Corbett, A., Orrell, M.et al. (2018). Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people living with dementia: a cluster randomised control trail. PLoS Medicine, 15, e1002500CrossRefGoogle Scholar
Moniz-Cook, E., Roberts-Stride, K., James, I.et al. (2012). Functional analysis-based interventions in challenging behaviour in dementia. Cochrane Database, 1, CD006929. doi: 10.1002/14651858.CD006929Google Scholar
Algase, D. L., Beck, C., Kolanowski, A., Whall, A., Berebt, S., Richards, K.et al. (1996). Need-driven dementia compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer’s Disease, 11, 1219.Google Scholar
Ballard, C., Orrell, M., YongZhong, S., Moniz-Cook, E., Stafford, J., Whittaker, R., Woods, B., Corbett, A., Garrod, L., Khan, Z., Woodward-Carlton, B., Wenborn, J., & Fossey, J. (2016). Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: a factorial cluster-randomized controlled trial by the Well-Being and Health for People with Dementia (WHELD) Program. American Journal of Psychiatry, 173, 252262.CrossRefGoogle ScholarPubMed
Banerjee, S. (2009). The Use of Antipsychotic Medication for People with Dementia: Time for Action. London, UK: Department of Health.Google Scholar
Brechin, D., Murphy, G., James, I. A. & Codner, J. (2013). Alternatives to Antipsychotic Medication: Psychological Approaches in Managing Psychological and Behavioural Distress in People with Dementia. Division of Clinical Psychology. BPS: Leicester.Google Scholar
Brooker, D. & Latham, I. (2015). Person-Centred Dementia Care: Making Services Better With VIPS Framework. London, UK: Jessica Kingsley.Google Scholar
Bunn, F. & Handley, M. (2019). Reducing agitation in care home residents with dementia. The Lancet Online, 6, 274. http://dx.doi.org/10.1016/S2215-0366(19)30080-XGoogle ScholarPubMed
Cerejeira, J., Lagarto, L. & Mukaetova-Ladinska, E. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73. doi: 10.3389/fneur.2012.00073CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2000). Use of patient characteristics to determine non-pharmacological interventions for behavioural and psychological symptoms of dementia. International Psychogeriatrics, 12, 373380.CrossRefGoogle Scholar
Cunningham, C., Macfarlane, S., & Brodaty, H. (2019). Language paradigms when behaviour changes with dementia: #BanBPSD (Editorial). International Journal of Geriatric Psychiatry, 34, 11091113.CrossRefGoogle Scholar
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53, 641.CrossRefGoogle ScholarPubMed
Hallet, N. (2018). Preventing and managing challenging behaviour. Nursing Standard, 32, 5163. doi: 10.7748/ns.2018.e10969CrossRefGoogle Scholar
Holle, D., Halek, M., Holle, B. and Pinkert, C. (2016). Individualized formulation-led interventions for analyzing and managing challenging behavior of people with dementia – an integrative review, Aging and Mental Health, 21, 12291247. doi: 10.1080/13607863.2016.1247429CrossRefGoogle ScholarPubMed
Howarth, A., Crooks, M. and Sells, D. (2017). The use of physical restraint to deliver essential personal care to incapacitated older adults with dementia. In James, I. & Jackman, L. (eds), Understanding Behaviour in Dementia that Challenges (2nd edn). London, UK: Jessica Kingsley Press.Google Scholar
Howarth, A. & Sells, D. (2014). The Forced Care Framework: guidance for staff. Journal of Dementia Care, 22, 3034.Google Scholar
HSJ (2020). Watch out for the trend: mental health matters (Rebecca Thomas). Health Service Journal (22 June 2020).Google Scholar
James, I. A. (2015). The use of CBT in dementia care: a rationale for Communication and Interaction Therapy (CAIT) and therapeutic lies. The Cognitive Behaviour Therapist, 8, e10.CrossRefGoogle Scholar
James, I. A., & Gibbons, L. (2019). Communication Skills for Effective Dementia Care: A Practical Guide to CAIT. London, UK: Jessica Kingsley Press.Google Scholar
James, I. A., & Jackman, L. (2017). Understanding Behaviour in Dementia that Challenges (2nd edn). London, UK: Jessica Kingsley Press.Google Scholar
James, I., Marshall, J. & Thwaites, S. (2017). Improving communication skills in dementia care: utilising the British Psychological Society’s stepped-care model for treatment of behaviour that challenges. Psychology of Older People: The FPOP Bulletin, 137, 3641.Google Scholar
James, I. A., Medea, B., & Reichelt, K. (in press). De-escalation strategies in the management of challenging behaviour in dementia: creating a competent and articulate workforce. Psychology of Older People: The FPOP Bulletin.Google Scholar
James, I. A., & Moniz-Cook, E. (2018). Evidence briefing: behaviour that challenges in dementia. British Psychological Society. www.bps.org.ukGoogle Scholar
James, I. A., & Reichelt, K. (2019). Understanding people’s needs: the 8-needs framework for the treatment of behaviours that challenge. Psychology of Older People: The FPOP Bulletin, 147, 2430.Google Scholar
Kaplan, S., & Wheeler, E. (1983). Survival skills for working with potentially violent clients. Social Casework, 64, 339346.CrossRefGoogle ScholarPubMed
Kitwood, T. (1997). Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press.Google Scholar
Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., Omar, R. Z., Katona, C., & Cooper, C. (2014). A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technology Assessment, 18, 1226. doi: 10.3310/hta18390.CrossRefGoogle ScholarPubMed
Macaulay, S. (2015). B is for BANGS: care partnering, challenging and solutions, tips and tools and skills (http://myalzheimersstory.com/2015/06/18/b-is-for-breathe-in-bangs/).Google Scholar
McCallion, P., Toseland, R. W., Lacey, D., & Banks, S. (1999). Educating nursing assistants to communicate more effectively with nursing home residents with dementia. Gerontologist, 39, 546558. doi: 10.1093/geront/39.5.546CrossRefGoogle ScholarPubMed
Moniz-Cook, E., Roberts-Stride, K., James, I.et al. (2012). Functional analysis-based interventions in challenging behaviour in dementia. Cochrane Database, 1, CD006929. doi: 10.1002/14651858.CD006929Google Scholar
NHS Protect (2017). Guidance on the Prevention and Management of Clinically Related Challenging Behaviour in NHS Settings: Meeting Needs and Reducing Distress. http://www.reducingdistress.co.uk/reducingdistress/wpcontent/uploads/2014/02/Meeting_needs_and_reducing_distress.pdf (accessed 31 January 2018.)Google Scholar
NHS Counter Fraud and Security Management Service (2003). Conflict Resolution Training: Implementing the National Syllabus. NHS, London.Google Scholar
NICE (2018). Dementia: assessment, management and support for people living with dementia and their carers. Guidance/ng97.Google Scholar
Rapaport, P., Livingston, G., Murray, J., Mulla, A., & Cooper, C. (2017). Systematic review of the effective components of psychological interventions delivered by care home staff to people with dementia. BMJ Open, 7, e014177.CrossRefGoogle Scholar
Sells, D., & Shirley, L. (2010). Person-centred risk management: the traffic light approach. Journal of Dementia Care, 18, 2123.Google Scholar
Stout, N. (2008). The public health approach to occupational injury research: from surveillance to prevention. Safety Science, 46, 230233.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Challenging behaviour in dementia care: a novel framework for translating knowledge to practice
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Challenging behaviour in dementia care: a novel framework for translating knowledge to practice
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Challenging behaviour in dementia care: a novel framework for translating knowledge to practice
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *