1. UNDERSTANDING the causes of behaviours that challenge Sean Page Consultant Nurse - Dementia

2. A reductionist model of explanation Behaviour D M NE I A E T

3. Changes in behaviour are as a direct consequence of dementia Most changes in behaviour are a problem That problem rests with the patient The solution to that problem rests with us

4. History Premorbid personality Physical health Mental health Environment Cognitive status Lived experience A broader explanatory approach Lived experience Filtered through Cognitive Abilities Unmet need

5. Cohen-Mansfield’s Unmet Needs Model Behaviour as an attempt to fulfil a need Behaviour as means of communicating a need Behaviour as outcome of frustration Unmet need

6. Cohen-Mansfield’s Unmet Needs Model Behaviour as an attempt to fulfil a need Behaviour as means of communicating a need Behaviour as outcome of frustration Unmet need

7. A holistic model of explanation - Stokes & Goudie (2002) Environment SocialBuilt Behaviour Context Health Person

8. A holistic model of explanation - Stokes & Goudie (2002) Environment Built Behaviour Context

9. Built Environment ‘It is naïve to propose a deterministic view of the relationship between buildings and people who live in them. ….. Buildings can hinder or help the provision of quality care: in extreme cases they can prevent it but buildings by themselves can never provide it’ ‘Quality of care depends upon staff morale, motivation and training. Hence it can be confidently argued that the quality of the social environment is of greater importance than the physical, for negative staff attitudes will negate the effects of even the best architectural design’.

10. A holistic model of explanation - Stokes & Goudie (2002) Environment Social Behaviour Context

11. Social Environment ‘Quality of care depends upon staff morale, motivation and training. Hence it can be confidently argued that the quality of the social environment is of greater importance than the built for negative staff attitudes will negate the effects of even the best architectural design’.

12. Aspects of MSP Accusation. Banishment. Disempowerment. Disparagement. Disruption. Ignoring. Imposition. Infantalisation. Intimidation. Invalidation. Labelling. Mockery. Objectification. Outpacing. Stigmatisation. Treachery. Witholding. From Kitwood (1991)

13. A holistic model of explanation - Stokes & Goudie (2002) Behaviour Context Health

14. Physical health

15. A holistic model of explanation - Stokes & Goudie (2002) Behaviour Context Person

16. The person

17. CBT cycle – understanding a person’s experience Thoughts ActionsFeelings What people say/shout Observations & CT themes (anxiety, depression, anger) What people do/don’t do NEED From Ian James public seminar 2005

18. TRIGGERS Behaviour Need & possible thoughts Conversations or vocalisations Mental health Life story Personality Social environment Physical health Appearance Neurological impairment Medication

19. A holistic model of explanation - Stokes & Goudie (2002) Environment SocialBuilt Behaviour Context Health Person

21. Sean Page Consultant Nurse – Dementia sean.page@wales.nhs.uk