The challenges of dementia

The real epidemic started about 20 years ago when cases of people with dementia rose dramatically around the world.


“Every year, there are 10 million new cases with an overall total of around 50 million, and the number of people who develop this disease is rising every day.” 

Quoted here.


Dementia is affecting the lives of patients but also their families. Everything changes with the diagnosis; memory deterioration, personality shifts, losing the ability to perform everyday tasks and depression are only a few of the many symptoms. 


However, most destroying is the change in behaviour, aggression, self-harm, verbal, and physical abuse. 

Dealing with the challenges of dementia, the wrong way

 When we are thinking of restraints, what do we have in mind?


15th-century machines used for punishment and torture, maybe vests and belts used in mental health facilities?


Would you be surprised that restraining furniture, sedative medications, vests, beds with cuffs, bed rails, tables, beanbags, gloves, belts, and removal of mobility aids are used unnecessarily in healthcare facilities on people with dementia? 


There are different restraints used on dementia patients in care homes and hospitals. Physical, mechanical, and technological restraints are used to restrict movement, a chemical is to sedate patients when they are restless. Psychological control takes away patients’ choice and setting restrictive limits in day-to-day life.  

Ethical issues


Restraints methods are commonly used around the world to prevent the challenging behaviour of a patient with dementia, and most healthcare professionals look at them as a beneficial tool to avoid self-harm or hurting others.

Although restraint should only be used in an emergency, they are used routinely despite that research and medical literature show evidence of harmful physical and psychological consequences of using them (Kısacık et al. ,2020). Healthcare staff have a false sense of patient security to protect them from falls; using physical restraint is meant to help this, but is this method ethical? Does non-maleficence gone too far?

People with dementia must be treated with dignity, which cannot be taken away because of mental illness, old age, handicap or through approaching death. Every patient has a right to autonomy, dignity, and privacy and unnecessary use of any restraint is taking it away from them (Woogara, 2005). 

Patients with dementia are struggling with memory loss, challenging behaviours, and they are losing decision-making capacity; this is permitting the healthcare staff to decide for them. Sometimes those decisions are wrong and lead to physical and mental harm of a patient.


Risks of using restraints


Restraints are used widely on people with dementia across care homes and hospitals, despite that there is no evidence that they prevent falls or secondary injuries. There is a list of physical injuries related to using restraints on elderly patients: from skin damage, bruising, ulcers to nerve injuries, asphyxiation, and sudden death, which occurs in patients with cardiac conditions.



Increased mortality, more extended hospital stays, tightening of tissues, incontinence, and infections are developed by overuse of vests and bed rails. 


For people with dementia, restraints are associated with a traumatic experience, loss of dignity and self-respect. Their mental state is deteriorating with the expansion of anxiety, aggression, and depression (Gastmans & Milisen, 2006).



The physical and psychological consequences of overusing a restraint on dementia patients are irreversible. Why do we still use it in the twenty-first century?



Other reasons for using restraints


There are many reasons why healthcare staff is using restraints on people with dementia. 


They are used legally to prevent patients from falls or self-harm, sometimes to administer medications or for protection of medical devices. 


Overuse of restraints is also associated with the shortage and attitude of staff, coping strategies, role perception, staff management and lack of training. 

However, it is often used for the convenience of staff and not the welfare of the person with dementia.



Here, the use of restraints on dementia patients should be recognised as an abuse.


Alternatives to restraints


Using restraints in healthcare facilities should represent the poor quality of care, lack of knowledge and failure to address the needs of the patient (Gunawardena & Smithard, 2019). 


At first, the healthcare management must look at the reason for the patient’s behaviour and reasons the restraints are used. By applying the right care plan, the necessity for the use of restrains could fall dramatically. Staff training on damage caused by restraints would be beneficial. 



One of the main reasons for the use of controls is fall prevention; that is why a different approach should be implemented. Helping a patient with dementia maintain balance and muscle strength is crucial. Moving the patient near the nurses’ station, using a lower bed, use of foam wedges and placing padded mats around the bed should be an alternative to restraint. 



There is also a soothing cognitive approach helpful in a situation when the patient is anxious: reducing noise levels, review of the lightning in the room, ongoing explanations of the procedures, calm voice and soothing music, aromatherapy and reminiscence therapy (Bendigo Health, n.d.). 



Establishing the aggressive behaviour of people with dementia and trying to resolve the problems without using restraints can challenge the staff.



However, there are many ways to manage the behaviour of a person with dementia.


Caring for people with dementia can often be challenging. Sundowning, aggressive behaviour and disorientation are hard to understand and manage. 

There is a thin line between using restraints for safety issues and overusing them for the convenience of the healthcare staff.


The extensive use of restraint on people with dementia is mostly caused by the lack of training, knowledge on dementia behaviours, lack of workforce and attitude of the care staff. 


Restraints should not be an answer to challenging behaviour, and it should be seen as a threat to mental and physical health, dignity, human rights and wellbeing.


Healthcare organisations around the world should provide restraint-free care for all patients with dementia, and this can be only achieved with the help of staff and the management. 


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