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An evaluation of behaviour monitoring charts for behaviours that challenge in an older adult inpatients dementia service

Nicole King (Department of Adult Community Mental Health, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK)
Ian Asquith (Department of Rotherham Older People’s Psychology, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK)

Working with Older People

ISSN: 1366-3666

Article publication date: 2 October 2023




This study aims to evaluate the quality of information recorded in Behaviour Monitoring Charts (BMC) for Behaviours that Challenge (BtC) in dementia in an older adult inpatient dementia service in the North of England (Aim I) and to understand staff perceptions and experiences of completing BMC for BtC in dementia (Aim II).


Descriptive statistics and graphs were used to analyse and interpret quantitative data gathered from BMC (Aim I) and Likert-scale survey responses (Aim II). Thematic analysis (Braun and Clarke, 2006) was used to analyse and interpret qualitative data collected from responses to open-ended survey questions and, separately, focus group discussions (Aim II).


Analysis of the BMCs revealed that some of the data recorded relating to antecedents, behaviours and consequences lacked richness and used vague language (i.e. gave reassurance), which limited its clinical utility. Overall, participants and respondents found BMC to be problematic. For them, completing BMCs were not viewed as worthwhile, the processes that followed their completion were unclear, and they left staff feeling disempowered in the systemic hierarchy of an inpatient setting.


Functional analysis of BMC helps identify and inform appropriately tailored interventions for BtC in dementia. Understanding how BMCs are used and how staff perceive BMC provides a unique opportunity to improve them. Improving BMC will support better functional analysis of BtC, thus allowing for more tailored interventions to meet the needs of people with dementia.



At the time of writing this article, the following author’s affiliation was as follows: Nicole King was at the Clinical and Applied Psychology Unit, University of Sheffield, Sheffield, UK. Nicole has since moved as per the affiliation at the beginning of the article.

The authors would like to express thanks to Dr Emma Wolverson, Clinical Psychologist previously of Humber NHS Foundation Trust, for her generous support and guidance when discussing their colour-coded behaviour chart system and helping to consider how it could be implemented in this service. The authors would also like to thank Dr Gemma Graham, Assistant Director for Psychological Professionals in Rotherham, for her helpful comments on the draft.


King, N. and Asquith, I. (2023), "An evaluation of behaviour monitoring charts for behaviours that challenge in an older adult inpatients dementia service", Working with Older People, Vol. ahead-of-print No. ahead-of-print.



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