Practice Implications
These brief practice snapshots show how the 6D Dementia approach can be applied in real-world settings. These examples are illustrative and reflective in nature, and are intended to show how staff and carers use the framework to make sense of distress in context, rather than to present evaluated outcomes.
Home setting
“What looked like refusal of care was actually fear and confusion as her dementia progressed.”
Click the tab below to expand.
A lady living at home with her husband, her main carer, was referred due to concerns about the sustainability of care. She was declining personal care support from domiciliary staff and community nurses supporting her physical health needs.
Her physical health was deteriorating, and there was a significant risk of hospital admission or care-home placement. At the same time, her husband was experiencing increasing carer strain, with concerns about his own health and the potential for care breakdown.
The situation was initially framed as “refusal of care”, with increasing pressure on both professionals and the family. Familiar approaches were becoming less effective as the lady’s dementia progressed.
What was introduced
Using the 6D framework, staff explored:
What was happening → Why the situation had changed → What might help
This supported a shift towards understanding the lady’s distress as linked to fear, reduced insight, and difficulty recognising unfamiliar people entering her home.
Interventions focused on stabilising care at home and reducing distress. Practice changes included::
- Domiciliary staff were supported with guidance on how to enter the home, introduce themselves, and build familiarity before offering care
- Advice was provided on timing, language and approach to reduce perceived threat and increase feelings of safety
- The lady’s husband was supported to adapt his communication style, recognising that previous patterns were no longer effective
Practice learning
Staff and family reflected that understanding the emotional experience behind the behaviour helped guide calmer and more consistent responses.
Distress reduced and the lady was able to accept support more consistently. Escalation was avioded, the immediate risk of crisis admission and care breakdown reduced, and she was able to remain supported at home with less strain on her husband.
Care home setting
“Using the framework helped staff move from reacting to distress to understanding what the person might be experiencing.”
Click the tab below to expand.
A lady living in a care-home setting was referred due to increasing distress and escalation. Staff reported that she was declining support with personal care, pacing frequently within the home, and displaying verbal and physical aggression.
Two incidents involved assaults on staff. As a result, the care home had issued an eviction notice and she was at high risk of an unnecessary hospital admission during a period of heightened distress.
Her physical health was deteriorating, and there was a significant risk of hospital admission or care-home placement. At the same time, her husband was experiencing increasing carer strain, with concerns about his own health and the potential for care breakdown.
Staff used the 6D framework to work through
What’s happening → Why might this be happening → What might help
This process supported a shift from viewing behaviour as “challenging” to understanding it as communication of unmet need.
Staff identified several contributory factors, including unmanaged pain, feeling unsafe, difficulties with communication, lack of meaningful occupation, and disorientation. The lady did not recognise where she was or who staff members were, which was contributing to fear and distress.
Using the framework helped staff to pause, reflect, and respond more consistently. Actions taken included:
- Her pain management was reviewed
- Staff were supported to adapt their communication style and approach to help her feel safer and more oriented
- Practical guidance was provided on offering support in ways that protected dignity and maximised independence
- Structured, meaningful activities were introduced to provide routine and reduce agitation
Staff reported feeling clearer and more confident in how they understood and responded to distress.
Distress reduced, escalation was prevented, and the immediate risk of crisis admission was avoided. The eviction was not progressed, and the lady was able to remain settled and content within her care-home placement.
NHS inpatient ward
“Recognising that he was frightened by hallucinations changed how staff approached care.”
Click the tab below to expand.
Staff on dementia inpatient ward were supporting a gentleman who frequently became distressed and declined support with personal care, clinical interventions and transitions. He experienced visual hallucinations, which he found frightening.
His responses were initially understood as agitation and resistance to care. Without a shared framework, staff responses varied between shifts, and situations were often managed reactively in the context of risk, time pressure and competing demands. This increased stress for both the individual and the staff team.
Staff were supported to use the 6D Dementia framework alongside digital micro-learning, providing a shared structure for understanding distress:
What’s happening? Why might this be happening? What helps next?
This reframed the behaviour as a response to fear linked to hallucinations, unfamiliar environments and reduced sense of safety.
Using the shared framework supported greater consistency across the team. Practice changes included:
- Acknowledging the gentleman’s experience rather than correcting hallucinations
- Offering reassurance and emotional validation during care and transitions
- Simplifying communication and prioritising staff introductions
- Adjusting the environment where possible to reduce triggers
The shared language supported calmer, earlier responses across roles and shifts.
Staff reflected that understanding the role of fear and hallucinations helped guide calmer and more consistent responses. Early feedback indicated reduced distress, fewer escalations during care during care interactions, and increased staff confidence in responding to hallucinations and dementia-related distress.
The approach was felt to align with ward priorities around patient experience, safety and workforce wellbeing.
Explore whether 6D could support you or your setting
Get in touch to request further information.
