Management of Challenging Behaviour in dementia at home and in care homes

We propose a programme of inter-related studies to evaluate whether providing family and staff carers with training and support in behaviour management for dementia symptoms, enables them to improve their coping strategies (process), minimise behavioural symptoms (intermediate outcome) and thus enhance well being in older people with dementia (definitive outcome). Building on our research on functional analysis as a treatment for challenging behaviour in care homes, together with international innovation from the US and Australia, we will develop a training and support programmes for staff supporting people and family carers to access specialist knowledge 24 hours a day; evaluate these within two pragmatic randomised controlled trials; and conduct a cost consequence analysis of methods for implementing functional analysis into regular practicePharmacological treatment for challenging behaviour has raised strong concerns due to the associated increased risk of cerebrovascular adverse events, falls, accelerated cognitive decline and reduced quality of life for people with dementia (Ballard 2005). Functional analysis (Moniz- Cook et al 2001; 2003; Teri et al 2005) is, we suggest, a ‘clinically sensible’, ‘scientifically grounded’ individually tailored person-centred intervention for family and staff carers. There are no UK studies of significant improvement following use of functional analysis in dementia, despite guidance that suggests that this is the treatment of choice. Sustainable research is now urgently required to develop person-centred interventions for challenging behaviour that are ‘standardised, yet flexible, scientifically grounded yet clinical sensible’ (Teri et al 2005). There is also a need explore the cost effectiveness of different models of delivery of within current health care provision. The interrelated innovations proposed will examine clinical and quality of life outcomes and cost consequences of functional analysis in the management of challenging behaviour in community and care home settings.To develop this programme we have drawn together clinical psychologists who are national and international experts and set this programme in Yorkshire, where previous feasibility research has been carried out.