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Alternatives to Restraint Use in Dementia Care

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Updated: August 8, 2006

Restraints are rarely the answer

Alternatives to Restraint in Dementia Care
So what is the answer? Caregivers have rights too. Home caregivers have a particularly difficult time if they are trying to cope alone. Institutions and care facilities are under pressure to keep their costs down, avoid litigation and staff retention, always an issue. So often in the past physical restraints were employed as a solution to the problem of containment and safety to the patient themselves and to others. Restraints, in general, do not hold the answer.

Restraints
The only restraints that do have some support if used occasionally and monitored closely are chairs with a lap-top table. The tables can be used for activities and food etc. The problem with them is that once this type of chair restraint is used to prevent a person with dementia getting up and falling is that they become a routine restraint rather than one that is under regular assessment for nursing care plans.

Medication
Careful use of medication can help reduce agitation and restraint use. It is very important that specialist clinical prescribing , supervision and regular assessment makes the level of drug use minimal. Overmedication in dementia care is a major problem. The aim medication use should be relieve the symptoms of agitation, violence but at a dose that is well tolerated without sedating the person to the point drowsiness and sleep. The person needs to function to their optimum ability.

Activity and Exercise
Everyone needs distraction and activities that entertain and engage them, and regular exercise. So often in care facilities people are left sitting around with nothing to do. People with dementia such as Alzheimer's must be offered and involved in activity that will interest them. Individual care plans are central to psychological and physical wellbeing.

Good Nursing Caregiving Skills
Keeping some one well cared for is central to minimizing agitation, violence, depression, skill loss. Regular bathroom visits, encouraging as much self care as possible, appropriate education in caregiving, proper supervision and State legislation to enforce good care provision are basic to care that gets rid or minimizes the use of restraints in the care of people with dementia with challenging or difficult behavior.

Article Sources Include: Pierre N. Tariot, MD. Medical Management of Advanced Dementia J Am Geriatr Soc 51:S305–S313, 2003. Journal of the American Geriatrics Society Volume 51 Page S305 - May 2003 doi:10.1046/j.1532-5415.5156.x Volume 51 Issue 5s2

Barry W. Rovner, Pearl S. German, Jeremy Broadhead, Richard K. Morriss, Larry J. Brant, Jane Blaustein and Marshal F. Folstein. The Prevalence and Management of Dementia and Other Psychiatric Disorders in Nursing Homes. International Psychogeriatrics (1990), 2: 13-24 Cambridge University Press. 1990 Springer Publishing Company

Stephen J. Bartels, M.D., M.S., Susan D. Horn, Ph.D., Randall J. Smout, M.S., Aricca R. Dums, B.A., Ellen Flaherty, R.N., GNP-C, Judith K. Jones, M.D., Ph.D., Mark Monane, M.D., M.S., George A. Taler, M.D., and Anne C. Voss, Ph.D., R.N. Agitation and Depression in Frail Nursing Home Elderly Patients With Dementia. Am J Geriatr Psychiatry 11:231-238, April 2003 © 2003 American Association for Geriatric Psychiatry.

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