Routine Restraint of Dementia Patients in English Hospitals Revealed in Groundbreaking Study
A comprehensive new study has uncovered that restrictive practices, including physical restraints and non-consensual sedation, are routinely used on dementia patients within hospitals across England. This research, the first of its kind, indicates these methods have become an embedded aspect of standard ward care.
Embedded Restrictive Practices in Ward Care
The report, conducted by academics at the University of West London, involved detailed ethnographic observation spanning 225 days across nine NHS wards in England. Researchers also conducted over 1,000 interviews with healthcare professionals. The findings reveal a troubling normalization of restrictive measures.
Common practices observed include raising bedside rails, blocking doors and pathways with furniture, issuing verbal commands to patients to sit down or return to bed, and administering physical interventions such as sedation without patient consent. Many hospital staff reportedly did not view these actions as restrictive due to their routine application throughout NHS facilities.
Staff members expressed uncertainty about alternative methods for caring for dementia patients, often citing concerns over patient safety and liability. They questioned how to manage individuals with dementia effectively without resorting to these measures to prevent harm to the patients themselves or others.
Significant Proportion of Hospital Admissions
Government figures indicate that up to 50% of all acute hospital admissions involve patients who are also living with dementia. These admissions frequently occur when a patient requires inpatient care following incidents like falls or separate illnesses. The high prevalence underscores the scale of the issue identified in the study.
Professor Andy Northcott, Professor of Medical Sociology at the University of West London and lead author of the study, provided critical insight. "This study is the first observation of its kind that examines the experience of people living with dementia during a hospital admission and how they are contained at the bedside throughout it," he stated.
Professor Northcott elaborated, "Once a person with dementia is admitted for any reason, they are essentially expected to remain in bed. A series of subtle to quite overt restrictive practices are employed to ensure the hospital can manage around them. These practices are largely intended to be in the patient's best interest, but they have a profound impact on the individual."
Negative Impacts on Patients
The immediate negative consequences for dementia patients subjected to these restrictive practices are significant. Patients often become agitated, upset, and express a desire to leave the ward, while struggling to comprehend their location. The report highlights that these measures can exacerbate patient distress rather than alleviate it.
Andy Woodhead, who lives with vascular dementia and was hospitalized after a fall, shared his personal experience. "I was confined to the bed and unable to go to the bathroom, so I had to use a urine bottle," he recounted. "I was made to feel as if I was being a bit of a nuisance." His testimony illustrates the emotional toll of such restrictive care.
Calls for Improved Care and Alternatives
The report recommends reducing the use of restrictive practices by encouraging staff to adopt alternative approaches. Suggested alternatives include supported walking, assisting patients with personal care, and actively listening and engaging patients in conversation to better meet their needs.
Paul Edwards, Chief Nursing Officer at Dementia UK, commented on the findings. "It is well known that the care of people living with dementia in acute hospital settings can be variable and often falls short of what patients and families should rightfully expect," he said. "This reflects a system under immense pressure, where staff frequently lack the time and specialist knowledge required to provide the dedicated support people with dementia need. People living with dementia and their families deserve care that recognizes their needs and supports them at their most vulnerable."
NHS Response and Guidance
An NHS England spokesperson addressed the study's findings. "People living 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 patients' safety," the spokesperson affirmed.
"The NHS has provided staff with guidance and training resources on how to keep patients safe using the least restrictive practices possible." This statement acknowledges the issue while pointing to existing frameworks aimed at mitigating such practices within the healthcare system.
