Using the Newcastle model to understand and manage behaviors that challenge in dementia: a case study

Behaviors that challenge (BC) are common in dementia and can have a significant impact on the wellbeing of the person with dementia, their family and staff in care homes. The Newcastle model is a biopsychosocial, person-centerd, approach that aims to support care staff and family members in order to manage BC within care homes by identifying and fulfilling unmet needs of the person with dementia. After outlining its theoretical basis and practical utility, we describe a case study where the Newcastle model has been implemented to manage sexualised behaviors and verbal aggression. The patient described is a lady with dementia residing in a care home where the staff felt unable to manage increasing incidence of these BC. Information from multiple sources was collated to conceptualise the behaviors and understand them in terms of unmet needs, which was followed by a process to develop corresponding practical strategies together with care staff and family. Following successful implementation of the Newcastle model, the care staff reported a reduction in BC on standardised instruments (Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory). The staff group also described increasing confidence in managing sexualised vocalisations as they had a better understanding with regards to premorbid history and personality, and an increased awareness of the impact of dementia on behavior. Complicating factors relating to staff stress and physical health conditions in older adults are discussed, and adaptations to the model are suggested in order to maintain treatment gains in the long-term.