Need-driven dementia-compromised behavior. An alternative view of disruptive behavior
Open accessAbstract
The disruptive behavior of persons with dementia is a problem of considerable clinical interest and growing scientific concern. This paper offers a view of these behaviors as expressions of unmet needs or goals and provides a comprehensive conceptual framework to guide further research and clinical practice. Empiricalfindings and clinical impressions related to wandering, vocalizations and aggression to support and illustrate the framework are presented
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The NDB model is a middle-range theory that describes dementia-related behaviors and illustrates the processes that produce them.
“The NDB model is a middle-range theory that describes dementia-related behaviors and illustrates the processes that produce them.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
The Introduction describes the NDB model as a framework for understanding wandering, vocalization, and aggression, and explains these behaviors through needs and interacting background and proximal factors. The paper calls it a conceptual framework, but our copy does not identify it as a middle-range theory. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe NDB model identifies and describes the causal processes through which interventions are expected to produce desired outcomes.
“It also identifies and describes the causal processes through which interventions are expected to produce desired outcomes.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
The Introduction describes how needs and background and proximal factors may give rise to dementia-compromised behaviors. Applications to practice and research uses those proposed relationships to suggest interventions, such as increasing social interaction to modify wandering. The paper does not establish the causal processes by which those interventions produce desired outcomes; it says the framework needs validation and recommends examining intervention effects. (LLM, conf=0.79)
Experimental — accuracy not yet measuredProximal factors in the NDB model induce a need state and precipitate dementia-related behaviors, given the context of risk-producing background factors.
“Proximal factors in the NDB model induce a need state and precipitate dementia-related behaviors, given the context of risk-producing background factors.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
The framework discussion (page unavailable) describes background factors as relevant to risk profiles and says proximal factors are likely to precipitate need-driven dementia-compromised behaviors. It treats changing needs and states as proximal factors, but does not say that proximal factors induce a need state; the claim also states as certain what the paper describes as likely. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe specific intervention theory that resulted from the consensus meeting combined the Need-Driven Dementia-Compromised Behavior Model (NDB) and the Neurodevelopmental Sequencing Program (NDSP).
“The specific intervention theory that resulted from the consensus meeting combined the Need-Driven Dementia-Compromised Behavior Model (NDB) 10 and the Neurodevelopmental Sequencing Program (NDSP).11”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
Dementia-related behaviors arise in part because of an unmet need.
“The model asserts that such behaviors arise in part because of an unmet need.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
The NDB model has challenged the prevalent view that dementia-related behaviors are simply part of the disease process.
“The NDB model has challenged the prevalent view that dementia-related behaviors are simply part of the disease process.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
Background factors identify people at risk for dementia-related behaviors and provide a profile of strengths and weaknesses.
“Background factors identify people at risk for dementia-related behaviors and provide a profile of strengths and weaknesses.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
Behaviors are seen as the most integrated and meaningful response a person with dementia can make at that time.
“Behaviors are seen as the most integrated and meaningful response a person with dementia can make at that time.”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
In the NDB model, relatively stable individual characteristics (background factors) interact with current situational variables (proximal factors) to produce dementia-related behaviors.
“In the NDB model, relatively stable individual characteristics (background factors) interact with current situational variables (proximal factors) to produce dementia-related behaviors (Figure 1).”
From Practice guidelines for recreation therapy in the care of people with dementia (CE) (2003) · cites this paper as [10]
Two high-quality studies found no immediate or longer-term effect (at 3 months, 6 months or 12 months) of either four or eleven sessions training family caregivers in BMT for severe or symptomatic agitation in people with dementia living at home.
“Two high-quality studies found no immediate or longer-term effect (at 3 months, 6 months or 12 months) of either four or eleven sessions training family caregivers in BMT for severe or symptomatic agitation in people with dementia living at home. 45,46”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [45]
The Applications to practice and research section proposes a framework for understanding disruptive behavior and suggests ways caregivers might respond. Neither that section nor the passages found by searching for caregiver training and follow-up outcomes report two studies, four or eleven BMT sessions, or effects measured at 3, 6, or 12 months. The available passages have no page numbers. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe need-driven, dementia-compromised behavior model conceptualizes behavioral and psychological symptoms of dementia as the result of the combination between the caregiver's inability to understand the patient's needs and the patient's inability to express them, and suggests that BPSD may represent attempts to express physical or emotional distress due to unmet needs.
“A different approach is provided by the need-driven, dementia-compromised behavior (NDB) that conceptualized BPSD as the result of the combination between the inability of the caregiver to understand patient's needs and the inability of the patient to express them. Therefore, BPSD may represent patient's attempts to express physical or emotional distress due to unmet needs.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [101]
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“, environmental and situational issues such as pain, fatigue, and noise); while background factors are quite stable, proximal ones are modifiable and represent the target for the interventions (101, 102).”
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- Authors
- Algase, D. L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., & Beattie, E.
- Affiliations
- University of Michigan (US)
- University of Arkansas for Medical Sciences (US)
- Wilkes University (US)
- James Cook University (AU)
- Venue
- American Journal of Alzheimer's Disease
- Publisher
- SAGE Publications
- Published
- 1996-11
- Volume
- 11
- Issue
- 6
- Pages
- 10-19
- ISSN
- 0888-4897 (ISSN-L)
- 1082-5207
- OpenAlex
- W2092377944
- Cited by
- 628
- References
- 91
- Citations by year
- 2026: 11 · 2025: 25 · 2024: 12 · 2023: 18 · 2022: 26 · 2021: 54 · 2020: 53 · 2019: 31 · 2018: 31 · 2017: 31 · 2016: 39 · 2015: 31 · 2014: 29 · 2013: 28 · 2012: 15
- FWCI
- 6.31
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- American Journal of Alzheimer s Disease & Other Dementias® (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- dementia, disruptive behavior, wandering, vocalizations, aggression, unmet needs, goal-directed behavior, conceptual framework, Alzheimer's disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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