An accessible explanation of behavioural formulation, the Newcastle Model and why formulation changes dementia care planning.
This article provides general education for care providers. It does not replace assessment by the resident’s GP, community services, safeguarding team, mental capacity decision-maker, prescriber or emergency services where required. Resident-identifiable information should not be shared through website enquiries.
Behavioural formulation explained
Behavioural formulation is the process of developing a working explanation for why distress or behaviour may be happening. It brings together dementia diagnosis, physical health, life history, personality, communication, environment, relationships, triggers and staff responses.
It is not about producing a clever label. It is about helping the team understand the person well enough to change the care response.
Why incident reporting is not enough
Incident reports tell you what happened. They rarely explain why it happened, why it happened then, why it happened with those staff, or why the same intervention keeps failing. A home can collect months of ABC charts and still lack a useful plan if nobody turns the information into a formulation.
What the Newcastle Model adds
The Newcastle Model is commonly used in dementia services because it looks beyond the immediate incident. It considers the person’s biography, physical health, emotional world, environment, relationships and the meaning of behaviour. The aim is to understand the person in context, not simply manage incidents.
The four Ps in dementia formulation
- Predisposing factors: long-standing factors that may make distress more likely, such as trauma history, personality, previous roles, dementia type or sensory impairment.
- Precipitating factors: possible triggers for the current pattern, such as infection, pain, a move to care, bereavement, staff changes or medication changes.
- Perpetuating factors: factors that may keep the pattern going, such as inconsistent responses, overstimulation, repeated confrontation or unmet needs.
- Protective factors: things that help, such as trusted staff, family knowledge, meaningful routines, humour, music, faith, walking or familiar objects.
What formulation can reveal
- Personal care distress linked to embarrassment, pain and loss of control
- Aggression linked to rushed approaches or fear, rather than deliberate hostility
- Exit seeking linked to previous roles, perceived responsibilities or anxiety
- Calling out linked to loneliness, poor vision or attachment needs
- Sexualised behaviour linked to disinhibition, boredom or misinterpretation of care interactions
Mini case example
A resident was repeatedly recorded as “aggressive during care”. Formulation showed a more nuanced picture. He had always been private, had pain when his shoulder was moved, became overwhelmed by two staff talking at once, and believed staff were entering his room without permission.
The plan changed from “use two staff and reassure” to a specific approach: knock and wait, use one familiar staff member to start, explain one step at a time, avoid lifting the painful arm without warning, offer control over clothing, and pause at early signs of fear.
Why formulation supports safer documentation
A formulated plan is easier to audit because it links observed behaviour to likely contributing factors and clear staff responses. It also makes it easier to review whether the plan is helping, rather than relying on vague statements such as “redirect as required”.
Sources and UK guidance basis
- NICE NG97, including person-centred care, life story, pain assessment, personalised activity and staff training.
- NICE QS184, distress in dementia and understanding possible causes before treatment is offered.
What this article cannot do
General articles can help teams think more clearly, but repeated incidents, safeguarding concerns, placement instability, complex family dynamics, prescribing questions or restrictive practice need case-specific review by the appropriate accountable professionals.
First Response Dementia Services provides focused dementia behaviour review, formulation and practical care planning support for care providers. The aim is to help teams understand the pattern, strengthen documentation and agree realistic next steps.