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Management of Agitation in Behaviours That Challenge in Dementia Care: Multidisciplinary Perspectives on Non-Pharmacological Strategies

James, Ian Andrew; Reichelt, Katharina; Shirley, Louisa; Moniz-Cook, Esme


Ian Andrew James

Katharina Reichelt

Louisa Shirley

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Professor Esme Moniz-Cook
Professor of Clinical Psychology of Ageing and Dementia Care Research/ Dementia Research Work Group Lead


Objective: NICE guidelines recommend non-pharmacological interventions as the first-line approach for the management of behaviours that challenge. Recent work, however, highlights dissatisfaction with the lack of detailed guidance in the national guidelines regarding non-drug interventions. This study examines the views of practitioners regarding non-pharmacological treatments. It further explores perspectives on non-pharmacological strategies used in the management of agitation occurring within episodes of behaviours that challenge. Methods: Forty-two experienced practitioners attended a workshop where behaviours that challenge were described as occurring in three phases of agitation, using a framework adapted from the Positive Behaviour Support framework (pre-agitation, triggering and escalating, high level). The participants were asked to populate a template derived from the adapted framework. The completed templates recorded the clinical strategies the participants found useful to (i) prevent the occurrence of agitation, (ii) de-escalate distress and (iii) deal with perceived high levels of agitation. Results: The Positive Behaviour Support conceptual framework was perceived by participants as helpful in organising their clinical work. A number of interventions were suggested as preventative strategies: music therapy, doll therapy, physical activity and generic person-centred communication skills to enhance wellbeing. In contrast, de-escalation strategies identified by the participants focused on reducing emotional distress. The approaches for dealing with continued high levels of agitation involved a number of “control and restraint” techniques as well as medication. Conclusion: The template allowed specialist multidisciplinary professionals to identify skills for the management of distress and agitated behaviour linked to the respective phase of arousal. The template has scope to guide practitioners to identify the detail needed for the management of behaviours that challenge. The findings have the potential to influence the contents of forthcoming guidelines on alternatives to psychotropics in dementia care.


James, I. A., Reichelt, K., Shirley, L., & Moniz-Cook, E. (2023). Management of Agitation in Behaviours That Challenge in Dementia Care: Multidisciplinary Perspectives on Non-Pharmacological Strategies. Clinical Interventions in Aging, 18, 219-230.

Journal Article Type Article
Acceptance Date Jan 19, 2023
Online Publication Date Feb 18, 2023
Publication Date 2023
Deposit Date Mar 4, 2023
Publicly Available Date Mar 13, 2023
Journal Clinical Interventions in Aging
Electronic ISSN 1178-1998
Publisher Dove Press
Peer Reviewed Peer Reviewed
Volume 18
Pages 219-230
Keywords Dementia; Behaviour; Distress; Micro-skills; Strategies; Positive Behaviour Support; PBS
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