Monday 19 August 2013

Restraints Destroy the Alzheimer's Spirit

In my very first post, Light a Candle, I talked about the belief that "it is better to light a candle than curse the darkness" (Eleanor Roosevelt). However, in order for there to be light, we have to experience the darkness. I dare say that restraints are the dark side of Alzheimer's disease and dementia, and whether or not you believe they have their place, it is undeniable that they have a profound impact on the person who is being restrained.

I was touched to my core recently when a very corageous woman shared her story about her mother who had spent the last hours of her life being physically and chemically restrained in an effort to keep herself as well as others safe. She was in the emergency department of a hospital and as a result of her escalating agitation, it was deemed necessary to use wrist straps to restrain her arms, uniformed security to sit vigil, and antipsychotic medication to try and get her "under control." It is heartbreaking to think about the way she experienced the last hours of her life.

That scenario has played over in mind as I couldn't help but draw comparisons with another scenario that I had recently read about. I recently finished the book, Heaven is For Real and there was a section in the book when the father described that it was necessary to physically restrain the boy who needed to have a medical procedure and the only way to accomplish that was through physical restraint. I also think back to my own children who needed to be physically restrained to get stitches, or have a medical procedure. Is there a difference between these two scenarios? If so, what?

Restraints in the Alzheimer's world come in the form of physical, chemical or environmental restraints. How do we ensure that restraints are used only in the smallest number of cases when there is absolutely no choice, by people who are knowledgable about dementia care and the full range of alternatives to restraint use have been explored?  I would like to say that under no circumstances are restraints appropriate, however, I don't know that that position is realistic. Or is it?

I do know that there is a difference between doing things from a place of compassion as compared to convenience. When my mother-in-law, Jessie was exhibiting really anxious and agitated behavior we were concerned that she was suffering. We ruled out all the physical causes and then went to work on other causes. In that process, we did agree to try antipsychotic medication with the goal being to observe her response and if she seemed to feel better, great.  If not, we would stop the medication and go back to the drawing board. I believe we were coming from a place of compassion, with our goal being to ease her suffering.

When the use of restraints of any nature, contributes to suffering we really have to ask ourselves what are we doing here?  There have been many times that thoughtful and compassionate discussions with family members resulted in a decision not to restrain, knowing that there was risk associated with that. That decision was often grounded in the knowledge that keeping people safe through restraint is often an illusion in that there is a tremendous risk to the body as well as the spirit.

I have a lot of questions about this whole topic and would love to hear other people's thoughts. Are restraints ever justified? If they are to be used, how do we ensure they are used with compassion and wisely? How do we create dementia friendly environments that reduce or eliminate the use of restraints?


1 comment:

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