Functional analysis-based interventions for challenging behaviour in dementia

Abstract

The delivery of FA has been incorporated within wide ranging multi-component programmes and study designs have varied according to setting - i.e. family care, care homes and hospital, with surprisingly few studies located in care homes. Our findings suggest potential beneficial effects of multi-component interventions, which utilise FA. Whilst functional analysis for challenging behaviour in dementia care shows promise, it is too early to draw conclusions about its efficacy.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…82 This integrated a number of features taken from the conceptual overview described above, including the growth of functional analysis in dementia care and the importance of including the context of CB in the analysis. Thus, although a central tenet of the approach was to teach staff and practitioners to carefully observe the person and their immediate environment before making assumptions about the function of the behaviour, the analysis of function moved beyond the mere completion of antecedent-behaviour-consequence charts and the reductionist assumption that behaviour is a function of its consequences.…”

“…The searches located 3335 references, from which 144 abstracts were retrieved. One hundred and twenty-six papers were excluded following our quality ratings and checks for duplication, and 18 were selected for review (see Moniz Cook et al, 82 table 2), with a baseline total of 2558 care recipients. The majority of these (n = 13) were within family care settings and just three were conducted in care homes.…”

“…The authors achieved reductions in antipsychotics equivalent to the original study in some cases, but conclude by outlining contextual barriers to implementation; they recommend revisions to the intervention to address these barriers. 84 Second, given the findings from the Cochrane review on the functional analysis-based interventions, 82 that effective interventions usually involve a component of psychotherapy or counselling directed at the family carer, we conducted a second review to gain an in-depth understanding of the potentially 'hidden' needs of families living with dementia and CB. This was thought to be important as a focus for the content of a multicomponent intervention for the management of CB in dementia in family settings, as two-thirds of families that receive professional support report an unmet need associated with behaviour management in dementia.…”

“…These are referred to as functional analysis-based interventions, as the approach was to assist practitioners to assess, analyse and then choose the most appropriate set of interventions ('actions') for a given episode of CB. Actions for these two components were extracted from the literature, including our overview in Chapter 1, the Cochrane review, 82 Interventions included in the third component of the decision support tool were not related to the person's unmet need, but arose from a new concept derived from our overview (see Chapter 1), relating to the needs of the caregiving system. These reflected, for example, the needs of the family carer for those living at home (such as counselling or skills training) and those of staff or the environment (such as training, skills enhancement or altering lighting or sound in a room).…”

“…The action-planning aspect of the intervention may be described as 'low intensity', 119 in terms of specialist input to the care home, particularly as significant time was spent interacting with the technology. Higher-intensity interventions were described in our functional analysis-based interventions review, 82 in which just three studies in the care home setting were found.…”