Restraints are sometimes use in an attempt to prevent harm for example, to prevent falls or to stop wandering. In some cases, they’re also used to manage “difficult” behaviour. Dementia is a degenerative brain disease which affects not just memory but also mood and behaviour. As neural pathways are lost, the person may be less able to interpret the world and communicate clearly. This can result in agitated and confused behavioural symptoms.
Behavioural and psychological symptoms of dementia can be challenging for aged care staff to manage. But restraints should only be used for short periods of time to protect residents or staff, and only after all alternatives have been exhausted. There is no reliable data on how often residents are physically restraine, but data from the 1990s and 2000s suggest between 12% and 49% have been restrained at some stage.
Safe from injuries
Physical restraints have historically use because they were thought to keep residents safe from injuries; so such as falling out of bed or off chairs. But research from the 1990s find that restraints actually increase the risk of injury. Take the use of bed rails, for instance. When a resident attempts to get out of bed after bed rails have install; so they are more likely to become entangled or fall. Alternative strategies might include lowering the bed and placing soft fall materials on the floor.
The use of physical restraint also increases the residents’ isolation from their peers and staff. As a result, residents are more likely to experience anxiety, depressive symptoms, and some form of cognitive decline. Positive social relationships protect against cognitive decline. So it’s important for age care residents to stay socially connect to their peers.
Chemical restraint is the use of sedative, antipsychotic and antidepressant medications, collectively known as psychotropics, which affect residents’ emotional and physical behaviour. Some estimates suggest almost one in two residents may be inappropriately prescribe these medications.
Psychotropic medications are prescribe for people with chronic depression or paralysing anxiety; but should be use in conjunction with psychotherapies. For those with more serious mental health conditions such as schizophrenia, they can be a necessity for stability.
However, these medications should not use for people who are wandering; also restless, or for being just uncooperative. Inform consent should be obtain from the patient and/or their family before psychotropic medications are administered, or in emergency situations, immediately after the fact.
Older people are often resistant to entering aged care. The royal commission recently heard testimony that people would rather die than go into aged care. So it’s not surprising that adjustment and behavioural issues may arise. Entering an aged care facility can be a very difficult process. It means adjusting to new people, routines, or recovering from a serious health condition. Many people living in aged care report multiple losses: of control, independence, identity, meaning, and trust.
Almost two in three aged care facilities are understaffed. Aged care staff are busy providing clinical care, delivering medications, and supporting activities of daily living such as bathing and dressing. This leaves little time or training to account for the social and psychological needs of residents.
While it’s important to increase the numbers of nurses and carers, it’s also important to address the underlining factors that lead to the use of restraint. Residents require emotional, social and psychological support to ease their adjustment into aged care, and address their social isolation and loss of independence.