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Enhancing understanding of the causes of stress and distress in dementia


New elearning resource for staff in acute care settings

The Psychology of Dementia team at NHS Education for Scotland (NES) has launched a new e-learning training programme for health and social care staff working in general hospital settings, called Stress and Distress in Dementia.  The training is available on learnPro and can be accessed at 

The resource has been developed to support delivery of Scotland’s National Dementia Strategy and 10-point National Action Plan as well as implementation of the Standards of Care for Dementia within acute settings.  It is aimed at staff working at the skilled level of dementia care - as identified within Promoting Excellence: A framework for all health and social services staff working with people with dementia, their families and carers. 

The resource will enhance understanding of the causes of stress and distressed behaviours in dementia using a biopsychosocial model, which allows consideration of not only physical and biological factors, but also other factors that may cause distress (such as psychological and social/environmental). It also explores evidence-based proactive and preventative strategies that can be used to improve the experience, care, treatment and outcomes for people with dementia, their families and carers while on the ward. It is important to acknowledge that working with distressed behaviour can, in itself, be stressful and upsetting. Therefore, the training also highlights the importance of identifying and responding to staff members' own stress and/or distress. 

The training consists of 3 modules:

  1. What is Stress and Distress in Dementia
  2. Preventing Stress and Distress in Dementia on the Ward
  3. What to do when Proactive Strategies have not Prevented Distress 

It takes approximately 2 hours to complete, although does not have to be completed in one sitting, and uses a variety of teaching methods, including clinical case examples, videos, and individual reflective tasks.  It also teaches practical techniques to understand and respond to stress and distress in dementia. 

There are approximately 88,000 people living with dementia in Scotland and this figure is set to rise significantly over the next two decades due to an ageing population.  Caring for people with dementia in acute hospital settings is a key priority for Scotland’s current National Dementia Strategy (2013-2016).  

The Mental Welfare Commission (MWC) reports that up to a quarter of acute inpatient beds are occupied by a person with dementia over the age of 65 years and highlights the need for specialist training and education in terms of enhancing the knowledge and skill among staff in these settings to work effectively with this client group. This is particularly important given that individuals with dementia who are in hospital tend to have poorer health outcomes with an increased risk of mortality and complications.  

In addition, the very nature of hospital admission can trigger an increase in stress and distress, as it often involves a number of transfers between wards and is a strange and unfamiliar environment to the person with dementia.  In fact the Government’s 10 point National Action Plan makes a specific commitment to minimise and respond appropriately to stress and distress in hospital settings. 

The online training was reviewed by a multi-professional reference group and piloted by staff working in acute settings across two health board areas (NHS Greater Glasgow and Clyde and NHS Fife).  Carers from Minority Ethnic Carers of Older People Project (MECOPP) were also generous with their time in reviewing the training content and providing personal accounts of their experiences of dementia care within acute settings.

Overall, the training was received positively with participants reporting that it had increased their confidence in responding to stress and distress in dementia and had promoted the development of appropriate work related skills and knowledge in this area.  

Some examples of comments from participants include:

“A really useful learning tool for staff working in hospital settings”

“This course covers a broad and relevant range of information.”

“The interactive tasks were engaging and thought provoking.”

“I found this training course very informative and believe it will be well received by health care staff.” 

Judy Thomson, NES Director of Training for Psychology Services, said:

“The psychological support of people with dementia in our acute care settings is one of the key priorities set out in Scotland’s National Dementia Strategy.  Stress and distress in dementia is a specific challenge within these settings and it is crucial that staff feel appropriately skilled and knowledgeable to recognise and respond to such distress.  The new e-learning resource uses an evidence-based approach to up-skill health and social care staff to promote understanding of the causes of stress and distress as well as how to respond effectively.  Having appropriately trained health care staff is integral in ensuring high quality services that produce positive outcomes for the individual with dementia, their families and carers.” 


Reference: PR2015-010 

Further Information From

Psychology Directorate, NHS Education for Scotland, email 

Note to Editors

  1. NES is NHSScotland's national education and training Board. We are responsible for supporting NHS services to the people of Scotland through the development and delivery of education and training for all those who work in NHSScotland. We work closely with a range of partners to deliver our vision of Quality Education for a      Healthier Scotland
  2. Mukadam N., Sampson E.L. (2011) A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. International Psychogeriatrics, 23(3):344-355.
  3. Sheehan B., Stinton C., Mitchell K. (2011) The care of people with dementia in general hospital. The Journal of Quality Research in Dementia, 8.
  4. Mental Welfare Commission (2011) Dementia: Decisions for Dignity, published by author.