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An evaluation of the effectiveness of a case-specific approach to challenging behaviour associated with dementia


Bird, Michael, Llewellyn-Jones, Robert H., Korten, Ailsa


Aging & Mental Health, Volume: 13, No.: 1, Pages.: 73-83

Year of Publication



Objectives: Treatment of challenging behaviour in dementia using standardized psychopharmacological or psychosocial approaches remains problematical. A case-specific approach was trialled in this study, based on extensive evidence that each case is different in aetiology, the effects of the behaviour on others and what interventions are possible given the available resources.; Method: Forty-four consecutive referrals for challenging behaviour (two-thirds in residential care) were assessed across multiple causal domains. Both assessment and development of interventions were undertaken in collaboration with family carers and care staff. Measures of behaviour and associated carer distress, as well as medication and service use, were taken pre-intervention and at 2- and 5-month follow-ups.; Results: Psychotropic medication was used with a minority of participants but, overall, antipsychotic use was reduced. Psychosocial methods predominated, with 77% of cases judged as mainly or entirely psychosocial by an expert panel. There were significant mean improvements in behaviour and carer distress. Using conservative criteria there was a 65.9% clinical success rate.; Conclusion: Results confirm those of other studies which have used multifaceted interventions tailored to the unique needs of each case. They compare favourably with results from trials of standardized psycho-pharmacological or psychosocial approaches. More trials are needed, necessarily involving further development of robust methodologies which reflect the case-specific nature of challenging behaviour associated with dementia.;

Bibtex Citation

@article{Bird_2009, doi = {10.1080/13607860802154499}, url = {}, year = 2009, month = {jan}, publisher = {Informa {UK} Limited}, volume = {13}, number = {1}, pages = {73--83}, author = {Michael Bird and Robert H. Llewellyn-Jones and Ailsa Korten}, title = {An evaluation of the effectiveness of a case-specific approach to challenging behaviour associated with dementia{textdagger}}, journal = {Aging {&} Mental Health} }


aged, aged, 80 and over, attitude of health personnel, behavior, caregivers, case management, dementia, drug therapy, female, humans, male, methods, outcome and process assessment health care, patientcentered care, psychology, psychotropic drugs, residential facilities, stress, psychological, therapeutic use

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Before and After Study

Type of Outcomes

Behaviour, Carers’ Mental Health, Service use or cost reductions (incl. hospital use reduction, care home admission delay)


Extra Care Housing, Long Term Residential Care without medically trained staff, Nursing Homes

Type of Interventions

Intervention for Carers, Non-pharmacological Treatment, Workforce oriented interventions

Non-Pharmaceutical Interventions

Case management / Care navigator

Carer Focussed Interventions

Training programmes / workshops including behavioural training

Workforce Interventions

Professional Training / Continuing Professional Development