People with dementia are being subjected to restraints and non-consensual sedation while in hospitals 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 patients with dementia having bed rails raised, doors and paths blocked by furniture, receiving verbal commands to sit down or return to bed, and physical interventions such as non-consensual sedation.
The report, produced by academics at the University of West London, involved analysis of 225 days of ethnographic observation in nine NHS wards in England along with more than 1,000 interviews with healthcare professionals.
They also found that many hospital staff did not consider these practices to be restrictive due to their routine use on all NHS wards, and staff were 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 patients also living with dementia. Many of these hospital admissions occur when a patient with dementia may require hospital care, such as after a fall or a 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 to look at the experience of people living with dementia during a hospital admission, and how they are contained at the bedside throughout.
“Once a person with dementia is admitted for any reason, they are essentially expected to remain bedridden and there are a number of subtle to quite overt restrictive practices that are used to ensure the hospital can manage their environment.”
He added: “These practices are largely done for the benefit 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 have an expectation to stay still. “Staff don’t like the restraint, they just feel it’s the only way they can manage a person living with dementia, because they feel responsible if that person were to fall.”
The negative impact of dementia patients experiencing restrictive practices ranges from becoming agitated, according to the report, to becoming angry and wanting to leave the room, without understanding where exactly they are.
Andy Woodhead, who suffers from vascular dementia and was admitted to hospital after a fall, said he experienced 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. “They made me feel like I was being a bit of a bother.”
The report recommended that to reduce the use of restrictive practices, staff should be encouraged to use alternatives such as supported walking, helping patients with self-care, and listening to and engaging patients in conversation.
Paul Edwards, director of nursing at Dementia UK, said: “It is well known that the care of people living with dementia in acute hospital settings can be variable and may not be up to par with 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 living with dementia and their families deserve care that recognizes their needs and supports them in their most vulnerable moments.”
An NHS England spokesperson said: “People living with dementia should always be treated with dignity in all care settings; Restrictive practices should only be used as a last resort and if absolutely necessary for patient safety.
“The NHS has provided staff with guidance and training resources on how to keep patients safe with the least restrictive practices.”
