Objective  To investigate the incidence and influential factors of challenging behavior and its management difficulty among elderly dementia patients in long-term care institutions.

  Methods  We selected 340 dementia patients aged≥60 years using convenience sampling at 3 long-term care institutions in Guangzhou city and surveyed them with Chinese Version of Challenging Behavior Scale (CBS) and a self-designed general questionnaire between September and November 2017.

  Results  Almost all the patients (99.1%) were identified with challenging behavior and management difficulty. The prevalence rate and management difficulty score for the top 5 challenging behaviors among the patients were 81.8% and 6.55 ± 5.216 for decreased self-care ability, 51.5% and 3.55 ± 4.817 for perseveration, 43.2% and 2.99 ± 4.452 for lack of motivation, 43.5% and 2.93 ± 4.617 for unreasonably shouting and screaming, and 42.1% and 2.62 ± 4.141 for restlessness, respectively. The significant risk factors for challenging behavior and its management difficulty of the patients included poor self-care ability (partial ability: odds ratio OR = 2.869, inability: OR = 5.094), not undertaking psychiatric treatment (OR = 2.252), and with 3 or more comorbid disorders (P < 0.05 for all).

  Conclusion  Challenging behaviors and its management difficulty are prevalence and mainly influenced by self-care ability, psychiatric treatment status, and comordid diseases among elderly dementia patients in long-term care institutions.