Figure 8.1NCBT activity grid (Mackenzie 2008)
Tables
Table 1.1List of common behaviours that challenge (BCs)
Table 1.2Some questions to be used in the case of physical non-aggressive behaviours
Table 1.3BC categories derived from an audit of NCBT clinical work
Table 2.1The common biopsychosocial causes of shouting
Table 2.2The common biopsychosocial causes of sexual disinhibition
Table 2.3The common biopsychosocial causes of aggression
Table 2.4The common biopsychosocial causes of stripping
Table 2.5The common biopsychosocial causes of walking with/without purpose
Table 2.6The common biopsychosocial causes of absconding
Table 2.7Beliefs and thoughts associated with BCs
Table 2.8BC measures and tools
Table 2.9Frontal lobe functions
Table 2.10Some of the potential causal factors that are screened at referral
Table 2.11Cognitive deficits that may be causal factors in BC
Table 3.1List of medications used to treat challenging behaviours
Table 3.2The top five psychotropics chosen for Bishara’s three vignettes
Table 4.1Non-pharmacological approaches and their evidence-base
Table 4.2LCAPS guidelines for working with care staff
Table 5.1Cognitive themes and their relationships to emotional appearance
Table 6.1LCAPS guidelines for working with care staff
Table 6.2The stages of the ‘5 plus 9’ NCBT treatment model
Table 6.3Some of the skills required to work with staff in care facilities
Table 6.4Cognitive themes and their relationships to emotional appearance
Table 6.5Illustration of how the emotional presentation of the person can help identify need and develop the intervention
Table 7.1Queries and responses: demonstrating how therapists’ questions can help illuminate features underpinning the BC
Table 7.2John’s score on the FOT: an observation tool for assessing frontal functioning
Table 7.3Summary of NCBT Interventions (Makin 2009)
Table 8.1Demographics for areas in North East England that have BC teams
Table 8.2Summary of responses to the question ‘Do you engage in any of the following activities when using a toilet which is not in your home?’
Introduction
THE RISING PROFILE OF DEMENTIA
In recent years the topic of dementia has received a lot of attention internationally (Vernooij-Dassen et al. 2010). In 2010, the International Journal of Geriatric Psychiatry dedicated a special issue on the global response with respect to the management of dementia (Burns 2010). In the UK, all of the four home countries are publishing, or have already published, national dementia strategies and plans (England, Scotland, Wales and Northern Ireland). Throughout the world governments are preparing for the consequences of ageing populations and the tsunami of dementia related issues. This is in marked contrast to the whole of the previous century in which this condition received comparatively little attention at a governmental level in relation to conditions such as cancer and heart disease. The Health Economic Research Centre, UK (HERC 2010) calculated that Government and charitable spending on dementia research is 12 times lower than on cancer research (£50 million compared to £590 million), and less than a third of the spending on heart disease (£169 million). This is in contrast to the cost of the three diseases to the economy, with dementia costing £23 billion, cancer £12 billion and heart disease £8 billion.
The major spurs in the UK have been key publications such as the National Audit Office’s ‘Improving Services and Support for People with Dementia’ (NAO 2007); ‘Remember, I’m still me’ (CC/MWC 2009) and the National Dementia Strategies for England (DoH 2009) and Scotland (Scottish Government 2010). Many of the influential documents have been critical of existing service provision. For example, The Audit Commission’s publication of ‘Forget Me Not’ (CHAI 2002) was critical of the role of professionals, particularly primary care services, and ‘Living Well in Later Life’ (2006) described the problems in attempting to implement the National Service Framework for Older People (DoH 2001).
To illustrate some of the reasons for the UK government’s concerns consider the following data and demographics (information from NAO 2007; DoH, National Dementia Strategy for England 2009b; Time for Action report, Banerjee 2009; HERC 2010):
•820,000 people in the UK have dementia; this is 1.3 per cent of the population. The majority of these people live in England.
•Approximately 30 per cent of people (230,000) with dementia in the UK live in care homes.
•15,000 people with dementia are under 65 years of age, and services for this younger group are underdeveloped.
•15,000 dementia sufferers come from minority ethnic groups, and this figure is set to rise sharply owing to the ageing of people who settled in the UK from the 1950s onwards.
•69 per cent of General Practitioners (GPs) do not believe they have received sufficient training to diagnose dementia and manage difficult behaviours. This is a decrease in perceived abilities compared to 8 years ago (‘Forget Me Not’ report 2002), and may be accounted for by the increasing expectation from service-users and their families.
•25 per cent of people with dementia in the UK are prescribed anti-psychotics,
