Restraining and sedating dementia patients ‘routine’ in hospitals in England, study finds | Dementia
People with dementia are subjected to restraints and non-consensual sedation when hospitalized in England, according to the first study of its kind.
These restrictive practices were found to be an “integrated aspect of routine ward care,” according to the analysis, with examples including dementia patients having bedside rails raised, doors and aisles blocked by furniture, verbal commands to sit or lie down again, and physical interventions such as non-consensual sedation.
The report, written by academics at the University of West London, involved the analysis of 225 days of ethnographic observation across nine NHS services in England, as well as more than 1,000 interviews with healthcare professionals.
They also found that many hospital staff did not view these practices as restrictive due to their routine use in NHS services, with staff wondering how else they could care for dementia patients to keep them safe without harming themselves or others.
According to government figures, up to 50% of all acute hospital admissions are to patients who also have dementia. Many of these hospitalizations occur when a patient with dementia may require hospital care, such as after a fall or separate illness.
Professor Andy Northcott, Professor of Medical Sociology at the University of West London and lead author of the study, said: “This study is the first observation of its kind that examines the experience of people with dementia when admitted to hospital and how they are contained at the bedside throughout that hospitalization.
“Once a person with dementia is admitted for whatever reason, they are essentially expected to stay in bed and there are a series of subtle or quite overt restrictive practices that are used to ensure the hospital can manage their situation.”
He added: “These practices are largely done to be in the best interests of the patient, but they have a huge impact on the person they are applied to. The immediate negative impact is that they don’t necessarily know where they are and expect to sit still. Staff don’t like this restriction, they just think it’s the only way to manage someone with dementia, because they feel responsible if that person falls.”
The negative impact of dementia patients subjected to restrictive practices ranges from agitation, according to the report, to annoyance and a desire to leave the ward, without understanding exactly where they are.
Andy Woodhead, who suffers from vascular dementia and was admitted to hospital after a fall, said he faced such restrictive practices from hospital staff. “I was confined to bed and couldn’t go to the bathroom. So I had to use a urine bottle,” he said. “I felt like I was a bit of a nuisance.”
The report recommends that in order to reduce the use of restrictive practices, staff should be encouraged to use alternatives such as assisted walking, helping patients with their personal care, and listening and engaging patients in conversation.
Paul Edwards, chief nursing officer at Dementia UK, said: “It is well known that the care provided to people with dementia in acute hospital settings can be variable and not what patients and their families should expect. This reflects a system under immense pressure, where staff often lack the time and specialist knowledge needed to provide the dedicated support that people with dementia need.
“People with dementia and their families deserve care that recognizes their needs and supports them in their most vulnerable situations. »
An NHS England spokesperson said: “People with dementia should always be treated with dignity in every care setting – restrictive practices should only be used as a last resort and if absolutely necessary for patient safety.
“The NHS has provided staff with advice and training resources on how to keep patients safe with the least restrictive practices.”.
