Understanding Behaviour in Dementia that Challenges: A Guide to Assessment and Treatment

Kirsty Beart (Senior Lecturer in Health and Social Care, Nottingham Trent University)

The Journal of Mental Health Training, Education and Practice

ISSN: 1755-6228

Article publication date: 9 December 2011



Beart, K. (2011), "Understanding Behaviour in Dementia that Challenges: A Guide to Assessment and Treatment", The Journal of Mental Health Training, Education and Practice, Vol. 6 No. 4, pp. 211-211. https://doi.org/10.1108/17556221111194554



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

This text offers a clear and useful introduction to highlight the nature of behaviour that challenges (BC), when caring for people who have a diagnosis of dementia. It identifies an essentially humanistic approach to care which attempts to deal with the issue about compassion and choice versus order and control. During the last 20 years, this debate has centred on the priority of statutory care services to maintain safety and traditional problem solving approaches which have been challenged significantly by alternative person centred perspectives.

There are some very useful tables of categorised explanations for BC which could be invaluable for the training of carers. It should, however, be remembered that this is a model of aggregated evidence which should only ever be used as a starting point in the assessment to ensure the continuation of meeting the needs of an individual.

The debate on the use of medication to treat BC and its underlying causes such as pain, infections, psychosis, etc. offers a useful examination of why this issue needs to be considered as a priority for individual care. It is important to understand that the change of such an entrenched, traditionally led approach will need extensive training for carers and staff working with the service users concerned. The training would need to ensure the authors' non‐pharmacological techniques, as well as newly developed ones, were accepted as a viable alternative and that they have the potential to be commonplace in practice.

The authors “carer centred, person focused” model offers a great start to this process and there is perhaps room here to suggest the input of this type of care approach as standard. The “Newcastle Service” Specialist Challenging Behaviour clinical Model for a 14‐week programme and its guidelines offer a clear, structured and valuable approach. However, as the author comments this process has been criticised for being too time consuming and resource intensive. This may be not be true if considered in light of Quality of Life outcomes (see Brooker's (2008) chapter in Downs and Bowers, 2008), rather than staff efficiency and cost. The need to adapt this type of model to individual lives and care strategies are a good example of how these alternatives can become effective basic skills in the care methods adopted.

The Banerjee (2009) recommendations highlighted here, go some way to promoting this type of approach as a policy directive and perhaps signal the way to drive this forward structurally.

Ultimately, this text offers the reader, learner, teacher, carer and service users the starting point to understand the fundamentals of why Quality of Life outcomes are so vitally important in the care of vulnerable people who are dealing with dementia in their lives.

17 July 2011


Banerjee, S. (2009), “The use of antipsychotic medication for people with dementia: time for action”, A Report for the Ministry of State for Care Services, Department of HealthLondon.

Brooker, D. (2008), “Quality: the perspective of the person with dementia”, in Downs, M. and Bowers, B. (Eds), Excellence in Dementia Care: Research into Practice, Open University Press, McGraw‐Hill New York, NY, pp. 47691 (Chapter 26).

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