Hospital staff are sometimes confining patients with dementia to bed through controversial “containment and restraint” techniques, new government-funded research reveals.
The findings, paid for by the National Institute for Health Research, reveal that nurses and healthcare assistants are raising the siderails of beds and tucking bedsheets tightly around patients with dementia, reducing their mobility. Others are prevented from getting up by their walking frames being put out of reach or by being sedated with drugs. The techniques are used, say the researchers, because of an exaggerated fear that patients will fall if left to move around the ward freely. The study says the tactics lead to the “dehumanisation” of patients, leaving them angry and highly stressed and worsening their already poor #health.
The findings, which have been shared with the Observer, have triggered a fresh row over how the NHS treats people with dementia, who occupy up to half the beds in some #hospitals. Dr Eileen Burns, president of the British Geriatrics Society, which represents doctors, nurses and therapists who work with older people, said: “These findings are a huge concern. Sometimes the use of containment techniques is not justified.”
Burns added that too many ward staff perform “a custodial role” towards inpatients with dementia, though she said containment was sometimes needed to benefit the patient’s own health, as when bandages were placed over drips so they cannot be removed.
The research was undertaken by Dr Katie Featherstone, a reader in the sociology of medicine at Cardiff University and Dr Andy Northcott, a lecturer in allied health sciences at De Montfort University, Leicester. They studied in detail how dementia patients in 10 wards of five unnamed hospitals in England and Wales were treated over the course of 18 months. It was funded by the National Institute for Health Research, the Department of Health and Social Care’s research arm.
The researchers found that many dementia patients resist and reject the care provided to them in hospital because they are unhappy at their treatment, sometimes refusing to eat, or removing drips. Many protest at regimented regimes of fixed mealtimes and drug rounds they encounter while being treated for an ailment such as a breathing problem, broken bone or a urinary tract infection.
“At the bedside, staff response to resistance to care was one of containment and restraint. Raising the side rails of the bed or tucking bed sheets in tightly around the patient were both common means to contain a patient within the bed,” the study says. “For those sitting at the bedside, the close placement of the mobile tray table, unreachable walking frames and technologies such as chair alarms were used to contain people and keep them sitting in their bedside chair.”
Featherstone and Northcott conclude that the way staff deal with dementia patients, and the use of containment techniques, is “frequently the trigger of resistance or cause of patient anxiety”, though staff sometimes wrongly blame that on the dementia itself.
Their findings echo previous reports detailing inadequate care received by dementia patients published by Sir Robert Francis and the Care Quality Commission amongst others.