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Nature of behaviours that challenge in residents living in aged care homes: implications for psychosocial interventions and service development

James, Ian; Watson, Roger; Whitaker, Christopher; Stokes, Graham; Hart, Cathryn; Moniz-Cook, Esme


Ian James

Christopher Whitaker

Graham Stokes

Cathryn Hart

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


Background/Aims: Competing theories exist regarding the causes and nature of behaviours that challenge (BC). The present study attempted to provide better insight into these behaviours and determine whether there were any underlying relationships for people living in care homes with and without dementia. Methods: Cross sectional data for 2185 residents living in 63 UK care homes using the Challenging Behaviour Scale were collected. The incidence (i.e. presence/absence) of 25 commonly reported behaviours that challenge staff were determined using dichotomous scoring. Cluster analysis and Mokken scaling were used to examine underlying relationships. Mokken is a method of analysing data to determine whether there is a ‘latent’ structure within a data set. Results: The prevalence of reported BC was 87.5%. Cluster analysis revealed three main clusters: apathy, agitation with internal focus, agitation with active external focus. For seven of the 25 items a hierarchical model emerged, where behaviours at the bottom of the hierarchy tended to occur in the presence of those higher up. Behaviours at the bottom of the hierarchy (dangerous behaviour) were less frequently observed than the items at the top (lack of self-care, verbal aggression). Conclusion: Some common BC may occur in groups and themed clusters. This study has shown that a hierarchical structure of BC in residents may be present. The findings testify to the complexity in the aetiology and treatment of BC and hence the need for focussed high intensity bio-psychosocial interventions to be targeted towards those with high levels of ‘unmet need’. Implications for future research and practice are discussed.


James, I., Watson, R., Whitaker, C., Stokes, G., Hart, C., & Moniz-Cook, E. (2017). Nature of behaviours that challenge in residents living in aged care homes: implications for psychosocial interventions and service development. FPOP Bulletin, 19-27

Journal Article Type Article
Acceptance Date Aug 1, 2016
Publication Date 2017-04
Deposit Date Feb 28, 2017
Publicly Available Date Apr 30, 2017
Journal FPOP bulletin
Print ISSN 2396-9652
Electronic ISSN 2396-9660
Publisher The British Psychological Society
Peer Reviewed Peer Reviewed
Issue 138
Pages 19-27
Keywords Psychosocial interventions
Public URL
Publisher URL
Additional Information This is the author's accepted manuscript of an article published in FPOP bulletin, 2017, issue 138.
Contract Date Feb 28, 2017


Published article (215 Kb)

Copyright Statement
©2017 British Psychological Society

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