Dementia - responding to distressed behaviour
On this page you will find resources that discuss issues around responding to distress and behaviour that challenges in dementia. Guidance on the use of antipsychotic medication is also included.
In other sections of the website you can also:
- familiarise yourself with the UK national strategies and standards
- develop your skills and knowledge with resources designed for learning
- find details of key agencies and networks.
Resources are arranged under the following headings:
Some of the resources on this page are in PDF format - see how to access PDF files.
Resources and tools
NICE Pathways: Dementia overview
The dementia interventions section of the pathway includes interventions for non-cognitive symptoms and behaviour that challenges. View: dementia interventions.
RCN Principles of Nursing Practice
Principle A: Nurses and nursing staff treat everyone in their care with dignity and humanity - they understand their individual needs, show compassion and sensitivity, and provide care in a way that respects all people equally. Details of RCN resources that support dignity are at Principle A.
SCIE Dementia Gateway: Difficult situations
This section of the Dementia Gateway which brings together tools, activities and practical tips includes areas on: aggressive behaviour; a different reality; problems related to using the toilet; repetition; walking; refusing help; sexual expression; being withdrawn.
Antipsychotic medication
1000 Lives Plus (2010) Improving dementia care (How to guide)
This guide, published as part of the 1000 Lives Plus improvement programme in Wales, is arranged according to five key drivers and describes the interventions for each driver which have been shown to be effective. The key driver around improvement of community mental health services for people with dementia (including those resident in care homes) identifies the reduction of inappropriate use of anti-psychotic medications and use of alternatives as a priority intervention.
Alzheimer's Society: Antipsychotics
This section in the Alzheimer's Society website brings together resources to support best practice in the use of antipsychotic medication. It includes an antipsychotics position statement, a factsheet, questions to ask about antipsychotics and information for GPs.
British Psychological Society: Alternatives to antipsychotic medication: Psychological approaches in managing psychological and behavioural distress in people with dementia (PDF 859KB)
This briefing paper from the British Psychological Society's Faculty of the Psychology of Older People, is the first in a series of reports on dementia care that the faculty is producing in conjunction with the Dementia Action Alliance. It highlights the evidence-based alternatives to antipsychotic medication for people with dementia. By using a stepped-care approach, access to these interventions can be increased and the reliance on antipsychotics reduced. The model presented is designed to help NHS commissioners, general practitioners, service providers and specialist teams who are considering how to care for people with dementia.
Dementia Action Alliance: The Right Prescription: a call to action on the use of antipsychotic drugs for people with dementia
A Call to Action, launched by the Dementia Action Alliance and the NHS Institute for Innovation and Improvement aims to improve the quality of life of people with dementia and their carers by reducing the inappropriate use of antipsychotics for these people. All people with dementia should receive a clinical review from their doctor to ensure that their care is compliant with current best practice and guidelines, and consideration of alternatives to medication is given. See also related resources at the NHS Institute for Innovation and Improvement page on The Right Prescription.
Medicines and Healthcare products Regulatory Agency (MHRA): Antipsychotics learning module
This module identifies the most important hazards of antipsychotics and informs on actions that health professionals can take in order to anticipate, minimise and manage the risks. It is intended for use by the medical, nursing and pharmaceutical professions and is especially suitable for pharmacists, general practitioners and those starting out in psychiatry.
NHS Information Centre for health and social care: National Dementia and Antipsychotic Prescribing Audit
The audit collects information from GP practices on the use of antipsychotic medication for people with dementia and compares the treatment received against the findings of the report by Professor Sube Banerjee published in 2009 and made available on the Department of Health website: The use of antipsychotic medication for people with dementia: Time for action.
Nursing Standard (2012) Antipsychotic drugs in dementia: a best practice guide
This guide aims to summarise some of the main considerations in the prescribing of antipsychotic drugs to people with dementia. It includes a range of examples illustrating good practice around management of antipsychotic medication and use of non-pharmaceutical approaches.
SCIE Dementia Gateway: Dementia and anti-psychotics tool
This online tool looks at the over-use of anti-psychotic medication that is prescribed for people with dementia. It is helpful for all involved in supporting people with dementia, and enabling people with dementia to live with dignity.
Stories and good practice examples
Practitioners have shared improvements they have made in the delivery of dementia care and services describing what changes occurred as a result of their initiatives and what they learned from the experience. The stories have been arranged according to the five key ingredients in the Commitment to the care of people with dementia in general hospitals. To read these improvement stories see Best practice examples.
Patient Voices: The day the singing stopped. A patient story looking at dementia and challenging behaviours
The Patient Voices programme developed by Pilgrim Projects works with healthcare professionals, carers and patients to enable them to develop their own stories and narratives and is involved in ongoing research and development on the use of digital storytelling in health and social care. This story looks at dementia and challenging behaviours.
SCIE Dementia Gateway: Difficult situations - case studies
This section of the Dementia Gateway which brings together tools, activities and practical tips includes five case studies exploring some of the most common difficult situations that can arise when supporting a person with dementia.
- Responding to feelings unlocks solutions.
- Teamwork and leadership: the solution for difficult situations
- Active listening in action
- Why oh why? Creative brainstorming solutions to toilet problems.
- Reality check? When a person with dementia talks about something that doesn’t exist.
SCIE Dementia Gateway, Dementia Good Practice Examples: Challenging behaviour in older people’s residential care
Northumberland, Tyne & Wear NHS Trust Community Mental Health teams have developed a support service to older people's care homes to enable residents with challenging behaviour avoid hospital admission.
Standards
For relevant standard statements and associated guidance see:
NICE quality standards: Dementia standard
See statement 7.
Scottish Government: Standards of care for dementia in Scotland
As a person with dementia:
I have the right to be regarded as a unique individual and to be treated with dignity and respect.
For overarching resources and resources on other specific aspects of care see Supporting people with dementia.