Challenging behaviour in dementia in care homes is defined as the interaction
between behavioural and psychological symptoms in dementia (BPSD) and staff
experience of these. Rating scales that measure BPSD do not appear to measure
associated resident behaviour which staff find difficult to manage. The Challenging Behaviour Scale (CBS) was therefore developed, using 25 homes across England to evaluate its psychometric qualities.
A literature review highlighted bio-psychosocial approaches to intervention in
challenging behaviour in dementia. Thus, a staff-training programme, focusing on the resident's adaptation to the effects of dementia and the home environment, was developed. The effects of this 'person centred' programme were evaluated in five homes. Whilst resident behaviour did not alter, training had a positive effect on staff perception, improving their management of resident behaviour. However, these effects had not been maintained nine months later. Both sociocultural (organisational) variables and the severity of BPSD may explain these results.
The predictors of staff perception of difficult resident behaviour were: supervisor
support; the potential to relate to the resident as an individual; and staff anxiety.
Younger staff were more burnt out. The predictors of staff stress and burnout were: perceived difficult resident behaviour; lower job satisfaction; lack of clarity about the job; poor organisation and routines for residents; few opportunities for residents to influence the running of the home; and increased work pressure. In homes with fewer proportions of care assistants, job satisfaction and supervisor support were lower; burnout was greater; and residents spent more time doing nothing. Apathy was seen as a significant challenge for care staff. On average there were one or two severely challenging residents per home. The application of individualised bio-psychosocial intervention according to the proposed 'person-centred' model is described in ten homes. Potential for intervention research on the basis of this, is suggested.