1. Understanding and Responding to Challenging Behaviour ‘Understand the message and engage with the need that is not being met’

2. Unmet needs It is widely recognised that most challenging behaviour in dementia is an attempt at communication ‘unmet needs’ What may those needs be? Stokes (2001) “We can no longer assert that when cognitive functioning fails us, all that is left is our physical self. We must attend to the psychological needs of people with dementia if we want to improve their well-being.”

3. Unmet needs Kitwood (1997) “Satisfaction and well-being will only be attained when we address meaningfully the needs of those with dementia, needs which are common to all people, yet may be heightened by the experience of dementia.”

4. Physical needs Challenging behaviour may result from pain People with dementia DO FEEL PAIN, but may not understand it and respond with anger or fear. Privacy, dignity and respect in care Poor care often results in annoyance and frustration, which are common triggers for challenging behaviour.

5. The need for security We all need to feel psychologically safe Fear and frustration is one of the main causes of challenging behaviour in dementia Night time can be very traumatic Lots of different staff may cause insecurity Resistance or aggression may result from a poor approach

6. The need for occupation To be engaged in occupation and have stimulation is fundamental to psychological well-being Under stimulation is a cause of challenging behaviour in dementia

7. Social and human contact need Social contact is crucial to well-being and has a protective effect against psychological distress People need to feel a sense of belonging

8. The need to know Humans are inquisitive beings! Due to confusion and disorientation, people with dementia have an increased need to know, and seek information from those around them and from their environment People will seek meaning and comfort.

9. Egocentric needs We all need to have self-respect, self- determination and control, and a sense of possession (mine) Challenging behaviour in dementia is often caused by staff failing to acknowledge or to meet egocentric needs.

10. Sexual needs There is no age at which sexual activity abruptly ends yet the cultural expectation is for older people to be asexual We cannot deny a person sexual expression, but need to ensure their safety and dignity

11. Repetitive questioning Short-term memory loss Boredom Human contact

12. Repetitive questioning Hard of hearing An unmet need

13. Understanding wandering Separation anxiety Confusion Habits of a lifetime Living life

14. Understanding wandering Physical discomfort Coping with stress Boredom Loneliness

15. Understanding wandering Fear Avoidance Perseveration Spatial awareness Sun downing

16. Understanding noise making Pain Environmental discomfort Talking to others Needs to be met Psychosis Under-stimulation Abandonment

17. Understanding noise making Stress reaction Over-stimulation Attention seeking

18. Understanding aggression Defensive behaviour Reality confrontation Alarm Misunderstanding events Psychosis Blaming others Goal frustration

19. Understanding aggression Poor communication Impulsive over-reaction