title: An evaluation of the effectiveness of a case-specific approach to challenging behaviour associated with dementia.
abstract: OBJECTIVE
  Treatment of challenging behaviour in dementia using standardized psychopharmacological or psychosocial approaches remains problematical. A case-specific approach was trialled in this study, based on extensive evidence that each case is different in aetiology, the effects of the behaviour on others and what interventions are possible given the available resources.
  
  
  METHODS
  Forty-four consecutive referrals for challenging behaviour (two-thirds in residential care) were assessed across multiple causal domains. Both assessment and development of interventions were undertaken in collaboration with family carers and care staff. Measures of behaviour and associated carer distress, as well as medication and service use, were taken pre-intervention and at 2- and 5-month follow-ups.
  
  
  RESULTS
  Psychotropic medication was used with a minority of participants but, overall, antipsychotic use was reduced. Psychosocial methods predominated, with 77% of cases judged as mainly or entirely psychosocial by an expert panel. There were significant mean improvements in behaviour and carer distress. Using conservative criteria there was a 65.9% clinical success rate.
  
  
  CONCLUSIONS
  Results confirm those of other studies which have used multifaceted interventions tailored to the unique needs of each case. They compare favourably with results from trials of standardized psycho-pharmacological or psychosocial approaches. More trials are needed, necessarily involving further development of robust methodologies which reflect the case-specific nature of challenging behaviour associated with dementia.
authors.affiliation: NSW Greater Southern Area Health Service & Australian National University, Queanbeyan, NSW, Australia. Mike.Bird@gsahs.health.nsw.gov.au
authors.forename: Michael
authors.initials: M
authors.lastname: Bird
authors.forename: Robert H
authors.initials: RH
authors.lastname: Llewellyn-Jones
authors.forename: Ailsa
authors.initials: A
authors.lastname: Korten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001519:Behavior; D017028:Caregivers / Q000523:psychology; D019090:Case Management; D003704:Dementia / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods*; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012112:Residential Facilities; D013315:Stress, Psychological
chemical_list: D011619:Psychotropic Drugs