People with dementia who develop symptoms that cause them significant distress, or develop behaviour that challenges us (BtC), are offered an assessment at an early opportunity to establish generating and aggravating factors.

"People with dementia can become distressed, which can lead to symptoms such as increased aggression, anxiety, apathy, agitation, depression, delusions, hallucinations and sleep disturbances. But these behaviours may have other causes, including pain, delirium, or inappropriate care. Understanding the causes of these behaviours and addressing them before offering treatment can prevent things getting worse and prevent any harm. It can also avoid the use of unnecessary interventions, such as antipsychotic medication, which may not manage the symptoms effectively. "Interventions to improve such behaviour or distress should be recorded in a care plan."

The dementia care pathway, full implementation guidance: "Poorly managed behavioural and psychological symptoms (which accompany dementia) may lead to increased distress, accelerated cognitive decline, inappropriate antipsychotic prescribing, unnecessary use of restraint and earlier admission to residential care."

British Psychological Society, Behaviours that challenge in dementia guidelines: "It's important to have a psychological understanding of the complex causes of behaviour that challenges (BtC) and related interventions to meet the needs of the person living with dementia. Central to the management of BtC is both ensuring that the needs of the person with dementia are met and resolving any unmet needs using individually formulated biopsychosocial approaches to intervention. Individually formulated case-specific approaches for BtC are the best method for intervening within both family and 24-hour care settings"

"Residents in care homes should have access to specialist dementia/mental health services for assessment and management of complex dementia needs, including management of mental health medications and behavioural and psychological symptoms of dementia (BPSD), such as depression, agitation, aggression, distress, and psychosis. This can be achieved through regular support from an integrated MDT. These specialist mental health and dementia staff can help train care home staff in managing BPSD and reducing inappropriate use of antipsychotics, and in ensuring appropriate use of the Mental Capacity Act 2005.

The Framework for Enhanced Health in Care Homes: "Care home staff should consider following the Newcastle Support Model and using tools such as ‘ABC’ (Antecedent, Behaviour, Consequence) charts to understand and manage behaviours that challenge."