A recent study from Duke-NUS Medical School has brought attention to the extensive use of physical restraints by caregivers of older adults with advanced dementia who are living at home. This highlights the need for improved guidance and alternative care methods. The study found that nearly half (47%) of the caregivers surveyed reported using physical restraints on their family members with dementia, indicating a lack of support and resources.
In Singapore, the number of elderly people is increasing rapidly, and it is predicted that by 2030, almost a quarter of the population will be 65 or older[1]. It is estimated that at least 10% of this age group will develop dementia[2]. While the use of restraints has been extensively researched and mostly banned in nursing homes in other countries, this study is the first to investigate how common they are and what factors lead to their use in home settings, where most elderly people with dementia in Singapore are cared for.
Assistant Professor Chetna Malhotra from the Lien Centre for Palliative Care at Duke-N
The person in charge of the study in the US stated that taking care of elderly people with severe dementia comes with its own set of challenges, especially when physical restraints are involved. While these practices are sometimes used for safety reasons, they can have negative effects on the physical and mental health of older adults. The use of physical restraints has been linked to issues such as depression, post-traumatic stress, incontinence, and an increased rate of cognitive decline.
The study, which was published in the Journal of the American Geriatrics Society, involved a survey of 215 family caregivers of patients with advanced dementia. The participants were recruited from public hospitals and home care.The study examined the use of restraints in nursing homes and hospices from May 2018 to March 2021. The researchers discovered that the most common types of restraints used were belts or sheet ties (56%), locked geriatric chairs with fixed tray tables (35%), hand mittens (31%), and ankle or wrist ties (25%). These restraints were primarily used for safety reasons, such as preventing falls and wandering, as well as for managing agitated behavior and preventing removal of catheters or feeding tubes.
It was noted by the research team that the use of feeding tubes has not been proven to improve the quality of life or prolong survival for older adults with severe dementia. Instead, clinical guidelines should be followed to ensure the best care for these individuals.Guidelines advise cautious manual feeding. Agitation is a complex response behavior that can be difficult for caregivers, especially when it is accompanied by irritability, restlessness, or, in rare cases, violence. This behavior also indicates unmet needs or a decline in health. Caregivers may require assistance in identifying the cause of the behavior and finding a way to handle it, such as reducing noise levels or playing calming music, to provide compassionate and responsive care without resorting to restraints. Survey participants had mixed opinions on how physical restraints impacted the quality of life for older adults.39% of respondents stated that their situation was unaffected, while 44% reported a decrease, and 17% reported an improvement. The research also revealed that caregivers who received strong emotional support from friends were less inclined to use restraints. Conversely, those experiencing higher psychological distress or having other caregiving duties were more likely to resort to restraint use. Dr. Ellie Bostwick Andres, the lead author of the study and a senior research fellow at the Lien Centre for Palliative Care at Duke-NUS, expressed worry about caregivers facing pressure without sufficient support.Caregivers who are struggling to juggle their jobs and caregiving responsibilities may see restraints as necessary for safety, but they may not fully realize the negative impact it can have on their loved ones.”
According to Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, “As Singapore deals with the challenges of an aging population, it is crucial to understand the use of restraints in home care. This study not only raises awareness but also calls for a shift towards more supportive approaches to dementia care at home, ensuring better outcomes for older adults and their families.”
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The webpage for the Well-being of the Singapore Elderly (WiSE) research programme can be found at om.sg/Research/Research-Programmes/Pages/Well-being-of-the-Singapore-Elderly-WiSE.aspx.
