Language has always played a powerful role in how we understand and support people living with dementia. Over the years, many terms have been used to describe a person’s experience — and too often, those terms have carried negative or stigmatizing connotations. Phrases such as “challenging behaviour,” “aggression,” or “violence” have historically framed the person as the problem, rather than helping us understand what they might be communicating.
As our understanding of dementia has evolved, so has our language. And this evolution is not superficial. Language is critically important. It shapes how we interpret someone’s actions, how we respond, and ultimately how people living with dementia are valued, treated, and cared for.
At HCPA, we have long encouraged terminology that avoids labelling and instead reflects empathy and curiosity — terms such as “behaviours of concern” or “behaviours of distress.” These phrases move us closer to recognising that behaviour is not random or “difficult”; it is meaningful.
Why language matters
The words we choose influence:
- How a person is viewed by those supporting them
- How they feel about themselves
- How others respond to their needs
- The quality of care they receive
When language focuses on the behaviour rather than the person, it can unintentionally reinforce stigma. When it focuses on need, it opens the door to understanding, compassion, and better practice.
A new consensus: Behavioural Expressions of Need (BEN)
At the 2024 Dementia Congress, attendees — including people living with dementia, nurses, managers, researchers, and care leaders — came together to discuss the terminology we use in practice. After thoughtful debate, a clear consensus emerged.
“Behavioural Expressions of Need (BEN)” was identified as the most appropriate and respectful term for describing the presentations we see in people living with dementia.
This terminology reflects a crucial shift: Instead of viewing behaviour as a problem to be managed, BEN encourages us to see behaviour as communication — an expression of unmet physical, emotional, social, or environmental needs.
Why BEN matters
“Behavioural Expressions of Need” aligns with the principles of:
- Person‑centred care
- Trauma‑informed practice
- Compassionate, curiosity‑driven support
- Understanding the person’s life history, preferences, and context
It reminds us that every action has meaning. Every expression has a cause. And every person deserves to be understood, not judged.
How to Apply BEN in Practice
Introducing the term is only the first step. The real impact comes from how we use it in day‑to‑day care. Here are practical ways to embed BEN into practice across your team and setting.
1. Start with curiosity, not judgement
When a person shows a behavioural expression, pause and ask:
- What might this person be trying to tell me?
- What need might be unmet?
- What has changed for them?
This shift in mindset is the foundation of BEN.
2. Look beyond the behaviour
Behaviour is the output, not the cause. Consider possible unmet needs such as:
- Pain or discomfort
- Hunger, thirst, or fatigue
- Loneliness or boredom
- Fear, confusion, or sensory overload
- Environmental triggers (noise, temperature, lighting)
- Unmet emotional needs (reassurance, connection, familiarity)
BEN encourages us to explore these possibilities rather than reacting to the behaviour alone.
3. Use life history as a guide
A person’s past experiences, routines, preferences, and values shape how they express need. Understanding their story helps you interpret their expressions more accurately and respond more meaningfully.
4. Respond with compassion and reassurance
When behaviour is seen as communication, the response naturally becomes more supportive:
- Approach calmly
- Validate feelings
- Offer comfort
- Reduce demands
- Adjust the environment
- Provide meaningful occupation or connection
Small changes can meet big needs.
5. Reflect as a team
BEN works best when everyone uses the same language and approach. Encourage teams to:
- Discuss BEN during handovers
- Reflect on what needs may be driving expressions
- Share successful strategies
- Avoid judgemental or labelling language
This builds a culture of understanding rather than blame.
6. Documenting using Behavioural expressions of need‑focused language
Recording observations in BEN‑aligned language helps maintain consistency and reinforces the person‑centred approach. For example:
Instead of: “Resident was aggressive during personal care.”
Try: “Resident showed a behavioural expression of need during personal care. They appeared uncomfortable and pulled away. Possible pain or fear — will explore further.”
This keeps the focus on understanding and meeting needs.
7. Review, adapt, and personalise
Understanding Behavioural Expressions of need is not a one‑off assessment — it’s an ongoing process. As needs change, so will expressions. Regularly review what’s working, what isn’t, and what might need to be adjusted.
For support and guidance on dementia email assistance@hcpa.co.uk or check out our latest training here