Managing Challenging Behaviours Without Medication

The first National Elderly Welfare Facility Conference and Research Meeting, known as JS Festival in Tochigi, brought together professionals who support older people in residential care, community services and clinical settings. Its workshop on managing challenging behaviours with non-pharmacological interventions focused on practical responses that protect dignity while improving safety and quality of life.

For Australian practitioners, the subject has immediate relevance. A resident in a Melbourne memory-care home, a person living with dementia in a regional Queensland service, or an older adult receiving support in Perth may express distress through shouting, wandering, refusal of care or physical aggression. These actions are often communication rather than deliberate opposition.

The workshop encouraged attendees to look beyond the visible behaviour and investigate unmet needs, environmental triggers and changes in routine. This approach aligns with person-centred care and with Australia’s emphasis on restrictive-practice reduction, supported decision-making and the Aged Care Quality Standards.

JS Festival also created space for research presentations, practical learning, study tours, networking and an exhibition of eldercare products and services. The event’s value lay in connecting evidence with the everyday realities faced by care workers, nurses, allied health professionals, facility leaders and families.

Reading Behaviour As Communication

Challenging behaviour can be a response to pain, constipation, hunger, fatigue, loneliness or fear. Hearing loss, poor vision and medication side effects may make ordinary interactions confusing. A resident who pushes away a meal might be nauseated, unable to recognise the food or overwhelmed by noise in the dining room.

The workshop promoted a structured assessment before intervention. Staff can record what happened immediately before the behaviour, what the person did, how others responded and what followed. Patterns may emerge around showering, shift changes, unfamiliar carers, crowded lounges or late afternoon restlessness, sometimes called sundowning.

Building A Personalised Support Plan

A useful care plan includes the person’s history, preferences, communication style, cultural background and lifelong routines. Someone who worked outdoors may settle after time in a garden, while a former musician may respond to familiar songs. For an older Australian from a migrant family, food, language and religious practice may be central to comfort.

Staff should agree on consistent responses and document what works. A calm tone, short sentences, extra processing time and two simple choices can reduce pressure. In a busy Sydney or Brisbane facility, this may require rostered quiet periods and better handover notes so that every worker understands the same approach.

Environmental And Sensory Strategies

The physical setting can either soothe or intensify distress. Glare, echoing corridors, alarms, television noise and confusing signage may contribute to agitation. Clear wayfinding, natural light, comfortable seating and access to a quieter room can make the environment easier to navigate.

Sensory interventions should be individual rather than imposed as a standard package. Hand massage, familiar scents, weighted items, music, folding laundry or time with a therapy animal may help some people and irritate others. Australian facilities must also consider hot weather, bushfire smoke, air conditioning and the practical limits of outdoor programs.

Meaningful Activity And Connection

Purposeful activity is often more effective than simply trying to keep a person occupied. Preparing vegetables, watering plants, sorting objects, looking through family photographs or helping set tables can restore a sense of capability. Activities should match the person’s abilities and stop before fatigue becomes frustration.

Social connection matters as much as occupation. Small group programs may suit an inner-city Melbourne home, while a regional service might draw on local community groups, libraries or cultural organisations. A familiar staff member, volunteer or family visitor can provide reassurance during transitions that otherwise trigger resistance.

Technology With A Human Purpose

Digital tools and assistive technology can support non-drug approaches when they are chosen around a person’s needs. Motion sensors may alert staff to unsafe wandering, while tablets can provide video calls, music or reminiscence materials. Technology should supplement attentive care, never become a substitute for conversation or observation.

Study tours at JS Festival showed how innovation can be integrated into daily practice. The account of study tour reflections offers a useful example of robotics supporting mobility while staff remain responsible for encouragement, consent and emotional reassurance.

Teamwork, Safety And Ethical Practice

A consistent team response helps prevent escalation. Staff can use a low voice, maintain a safe distance, keep an exit available and reduce the number of people speaking at once. If immediate danger exists, the priority is safety, followed by reassurance and a review of what led to the incident.

Non-pharmacological care does not mean ignoring medical causes. Sudden confusion, aggression or withdrawal may indicate delirium, infection, pain or another urgent condition. Nurses, general practitioners, pharmacists, occupational therapists and families should share information, especially when a medication review or clinical assessment is required.

The session also reinforced the ethical importance of consent and least-restrictive practice. Any intervention should be proportionate, reviewed regularly and explained in a way the person can understand. Australian providers should align local procedures with relevant legislation, clinical guidance and aged-care governance requirements.

Practical Lessons For Australian Services

The ideas presented at the Tochigi meeting can be adapted without requiring expensive refurbishment. Leaders can begin with observation, staff education and small environmental changes, then evaluate whether incidents, distress and reliance on restrictive responses decrease over time.

A service may also borrow ideas from hospitality and community venues when considering how people experience arrival, movement and social spaces. Even design details associated with welcoming celebrations, such as grand entrance ideas, can prompt thinking about lighting, visibility and a calm first impression—provided the result remains appropriate for older people and does not create sensory overload.

Useful priorities for a facility team include:

• Create a behaviour-support record that captures triggers, preferences and successful calming strategies.
• Train all shifts to use the same respectful language and de-escalation techniques.
• Review pain, hydration, toileting, sleep, hearing, vision and medication whenever behaviour changes.
• Offer meaningful activities connected with each person’s identity, skills and cultural background.
• Audit noise, lighting, signage, temperature and access to quiet or outdoor areas.
• Measure outcomes such as distress, incident frequency, staff confidence and use of restrictive practices.
• Share learning with families, allied health professionals and local service partners.

Continuing The Conversation Beyond The Event

Professional gatherings are most valuable when lessons continue after delegates return to their facilities. A manager might discuss one workshop idea at a handover meeting, test it with a single resident and invite staff to record observations. Small cycles of assessment and review can build a reliable evidence base for the service.

The JS Festival model connected research, practice and supplier expertise in one setting. For Australian readers, its central message remains practical: understand the person, investigate the cause, change the environment where possible and use human connection before medication. Event-related enquiries and historical conference information can be directed to the event secretariat.