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  • About challenge demcare

    Dementia is associated with behaviour that families and staff find difficult to understand and cope with. This can be described as `behaviours that challenge`.

    The way others perceive and manage the changes in day-to-day behaviour in dementia can influence the person and their family’s quality of life.

    Some ‘behaviours that challenge’ are often expressions of distress. Professional staff often manage this distress with drugs which are known to have harmful side effects and often do not work. Guidelines suggest that psychological treatments should be used as the first-line strategy.

    The reasons for distress in a person with a dementia can vary depending on their personal aspirations, whether they are feeling unwell and/or whether others understand them. The psychological treatment of choice is known as functional analysis. Functional analysis assists care staff and mental health practitioners to ‘detect’ the causes of the person’s distress and provide the support necessary in order to alleviate distress and overcome ‘behaviours that challenge’.

    Functional analysis is usually provided by clinical psychologists who may not be widely available in the NHS.


    To develop and test an interactive functional analysis-based e-learning course and decision support tool for mental health care practitioners who support family carers and for staff working in care homes.

    • Designed by specialist physicians, pharmacists and psychologists to:

    • Be easy for staff to access and use at their work place

    • Provide examples of how commonly occurring medical conditions and drugs can contribute to the person’s sense of ‘feeling unwell’

    • Provide a decision support system for care planning

    We also aspire to increase research capacity in dementia care across East and North Yorkshire and beyond, by involving as many people with dementia, carers and professionals as possible in our research.

    challenge demcare studies

    Challenge Demcare consisted of 2 projects, one involving care homes (ResCare) and one involving people living at home and their carers (FamCare). It was intended that both studies would include an evaluation of the users' experience, a randomised trial and a cost consequence study of the e-learning training course and decision support tool developed during the project (please see the screen shot below from the e-learning training course). Unfortunately it was not possible to conduct a randomised trial for FamCare and a cohort study was completed instead.

    Challenge ResCare

    This study is now complete. A study of whether access to the e-learning and decision support tool by staff in care homes can reduce 'behaviours that challenge'.

    Cluster randomised trial involving approx. 50 care homes in North and East Yorkshire.

    Click here for full abstract

    Click here for ResCare Protocol V7.0

    Challenge FamCare

    This study is now complete. An observational study of people with dementia and challenging behaviour living at home and their carers.

    Cohort study involving six NHS mental health organisations across England.