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Risks and concerns about restraint use
The following chart gives examples of uses and risks associated with the three types of restraints.
|Type of restraint||Minimal use||Inappropriate use||Potential risks|
|Physical||Use of a lap belt to help a person sit up and participate in an activity.||Use of a table tray on wheelchair to prevent a person from walking around.||Increased potential for falls.
Increased frustration and restlessness.
|Chemical||Use of medication to stop disruptive behaviour and allow a person to participate fully in daily life.
The medication plan has short-term goals, and the person is monitored closely and re-assessed regularly to ensure that the medication continues to allow participation in daily activities.
|Use of medication to stop disruptive behaviour, without proper assessment of side effects.||Increased confusion.
Increased disorientation. Increased potential for falls.
|Environmental||A protected garden with free access to the inside of a building.||A locked bedroom door.||Increased frustration and restlessness.|
Concerns for people with dementia
Research has shown that inappropriate use of restraints can hold back people with dementia. Here are some of the concerns:
Restriction of freedom: Restraints can make her less active and less independent. For example, a chemical restraint may leave her sedated and inactive. A physical restraint, such as a tray on a geriatric chair, may prevent her from moving freely, which can lead to frustration. The excessive or inappropriate use of some caregiving strategies may result in her being restrained. These restrictions of freedom can also lead to a loss of confidence and self-esteem.
Risk of harm or injury: Restraints can cause injuries. For example, if a bed rail is used, he may try to climb over it during the night to get to the bathroom. This could result in a fall.
Loss of abilities: The restrictions created by restraints may result in the loss of cognitive and physical abilities. For example, if she is sedated for long periods, she may never regain abilities that existed before the sedation.
Concerns for family members, health-care professionals and other caregivers
Risk of harm or injury: You may want to consider restraints if the person with dementia is at risk of harming himself or others. For example, a person who reacts aggressively to a situation may put someone close by at risk of harm. Or a person who responds aggressively to a situation may put other residents and staff at risk of harm.
Appropriate care strategies: Family members may not be aware of appropriate care strategies for behaviours caused by the disease, or the risks associated with restraints. This could lead to them using restraints themselves or requesting that health-care professionals use them.
Lack of understanding, training and human resources: Some health-care professionals lack understanding of the issues of dementia and behaviour. Consequently, they may not implement the preferred care strategies. Long-term care facilities may also lack the resources to provide quality care for people with the disease.