Behaviour Management and BPSD


Published: 26 May 2024

Challenging behaviours are a common symptom of many conditions, such as intellectual disability, autism and dementia.

When poorly managed, these behaviours can have far-reaching effects, including distress for the client, disruptions to the lives and comfort of other clients, and added stress and workloads for healthcare workers.

BPSD: Behavioural and Psychological Symptoms of Dementia

In a home or aged care setting, the behavioural and psychological symptoms of dementia (or BPSD) are common, however, still remain one of the biggest challenges to care staff. One study found that while many residential aged care staff understood the underlying causes of BPSD, they lacked the appropriate management skills and resources to deal with them appropriately (Ervin et al. 2012).

Mishandling of BPSD can lead to the inappropriate use of restrictive practices, which should be a last resort for care staff, but have time and time again been incorrectly used as a frontline approach to changed behaviours.

Behaviour Management and BPSD Under the Strengthened Aged Care Quality Standards

Standard 5: Clinical Care - Outcome 5.6: Cognitive Impairment under the strengthened Aged Care Quality Standards requires aged care providers to establish processes for:

  • Recognising and reducing situations that may lead to behavioural changes in older people with cognitive impairment
  • Recognising and addressing causes of behavioural changes in older people with cognitive impairment, including clinical causes.

(ACQSC 2024)

Managing Behaviours: Person-Centred Approach

The following tips will provide carers with a foundational understanding of behaviour management to ensure their clients receive effective person-centred care when displaying BPSD.

There are countless ways to handle changed behaviours, however, approaching the situation methodically with an assessment tool like the ABC Approach to Behaviour Management examines the behaviour from a person-centred perspective. The aim of this type of approach is to help us understand the aetiology of the behaviour and develop a suitable, consistent response for ongoing support (Crombie et al. 2007; Autism Spectrum Australia 2014; Krishnamoorthy & Anderson 2011).

ABC Approach to Behaviour Management

ABC approach diagram
  • A: Antecedent / Activating Event - What led to or caused the behaviour?
  • B: Behaviour - What is the behaviour?
  • C: Consequences - What is the result of the behaviour?
  • D: Decide and Debrief - What will be done differently to disrupt the behaviour?

(Loddon Mallee Regional Dementia Management Strategy n.d.)

A: Antecedent or Activating Event

The antecedent or activating event looks at direct or indirect triggers of the behaviour; the why, what, when, where and who.

These stimuli could include:

  • Organic causes - e.g. health conditions, pain, fatigue, effects of medicine etc.
  • Emotional state - e.g. happiness, anger etc.
  • Cognitions - e.g. what the person may be thinking.
  • Environmental factors - e.g. a noisy or unfamiliar environment.
  • Social relationships - e.g. interactions with other people.

(ABIOS 2021)

B: Behaviour

The changed behaviour should be defined clearly. Types of BPSD commonly seen include:

  • Wandering or absconding
  • Depression
  • Sundowning
  • Anxiety or agitation
  • Aggression
  • Disruptive or intrusive behaviour
  • Hallucinations or delusions
  • Socially inappropriate or disinhibited behaviour.

(Tible et al. 2017; Health.vic 2015)

Note, simply labelling the behaviour is not sufficient. You must be able to describe what was observed. For example, did the client yell, cry, punch or use particular words?

C: Consequences

The consequences of the behaviour are the responses from everyone involved. These could include those of the staff, family members or other residents who were witness to the behaviours.

  • Were they emotional and panicked in their response?
  • Did they simply ignore the behaviour?
  • Did they reprimand the client?
  • Were their actions calm and respectful?

(Synapse 2021)

D: Decide and Debrief

The final and additional step to the ABC Approach is to decide and debrief. This step allows the care team to come together to consider their findings and collaborate on the best way to manage the situation. Remember that in true client-directed care, the client themself is part of the care team and should be involved in this process, or alternatively, the client’s family or designated decision-makers.

Decisions on what actions to take could involve:

  • Using a calm, gentle manner when communicating with the person
  • Reducing the number of staff who interact with the person
  • Offering more stimulating or distracting activities or exercises
  • Stronger, more effective means of communication between staff about potential triggers
  • Removing certain stimuli from the environment, such as overly-bright lights or loud noises
  • Closely monitoring interactions between particular people
  • Addressing underlying emotions and referring to other healthcare services when necessary.

(Alzheimer’s Society 2021; Health.vic 2015)

The ABC Approach in Practice

Scenario: Ted is an 87-year-old resident in a secure aged care facility who is living with dementia. In his younger years, Ted was extremely active and would wake early every morning to walk to the corner milk bar to buy the newspaper.

Antecedent or Activating Event:

After waking early one morning, Ted attempts to leave through the front entrance of the facility, with the intention of walking to the shop to buy the newspaper. However, he is halted by the locked security-door, which requires a keycode to open.


Ted gets agitated and upset finding himself locked behind the door and begins to try to rattle and break the door latch. He is panicked and loudly demanding to be let out.


The staff member on shift responds to the behaviour in a confrontational manner (‘Hey! Stop that! What are you doing?! You’ll break the door! Go back to bed!’), attempting to stop Ted from waking and disturbing other residents. The staff member forcefully grabs hold of Ted’s wrists in an attempt to stop him from breaking the door lock. The staff member’s response only makes Ted more upset, increasing his distress. His behaviour continues to escalate into yelling and physical aggression.

Decide and Debrief:

After the incident, the care team debriefs with Ted’s family and learn about his history, habits and preferences of walking to get the newspaper each morning.

The team also notes that the response of the staff member who was on shift was inappropriate and recommends they take a day away from work to de-stress and undergo further communication and de-escalation education.

The team decides that the staff member rostered on each morning should now have a newspaper ready to offer Ted when he gets up in the morning, and respectfully offer to walk with him around the facility before returning him back to his room.


The ABC Approach to behavioural management works best when the client’s behaviour is clearly documented and understood. The first approach should always be non-pharmacological and should involve tweaking the personal and environmental elements that contributed to the event.

The client’s medical prescriber may consider a medication review if the behaviours remain ongoing. Many milder behaviours tend to run a course and can resolve in time, and so patience and support is often the best response in these cases (Krishnamoorthy & Anderson 2011).

Note: Always refer to your facility's policy on dealing with difficult or aggressive behaviours. If there is a real risk of danger to you or your clients, security may need to be called.


Test Your Knowledge

Question 1 of 4

Step ‘C’ in the ABC Approach to Behaviour Management refers to…?


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