Elderly restraints may be physical or chemical in nature. In some cases, elder patients may be given sedation medication to calm their nerves and placate the patients that seem to repeatedly disobey rules or requests. Some nursing home staff members have also been caught increasing doses of anti-anxiety or anti-depressant medications for elder patients in an additional effort the calm difficult patients. This often makes the elderly patient lethargic, and family members may notice a significant change in behavior or mood. It is illegal to increase an elder patient’s dose of medications without explicit instructions from a doctor.
In other nursing homes, some elder patients have been placed in physical restraint devices. These physical restraints are used under the premise that they will keep elders safe by preventing them from falling out of a bed, off of a chair, or off of a wheelchair. The nursing home staff may also claim that the physical restraints help minimize the risk of wandering. However, medical studies repeatedly indicate that the use of physical restrains is not only ineffective, but is also harmful for the elder patient’s health.
According to an article published by the Association of Rehabilitation Nurses, the use of physical restraints on elderly patients in nursing homes or assisted living facilities results in an assortment of negative outcomes. Elderly patients may feel depressed, helpless, confused, agitated, or aggressive as a result of physical restraint use. Physical restraints can lead to mental and physical illnesses.
Even when used properly, physical restraints frequently cause the following problems for elderly patients:
- Cardiovascular distress
- Muscle atrophy
- Functional decline
- Social isolation
- Loss of self esteem
- Broken bones, sprains, or other serious injuries as patients try to escape the restraints
- Decreased peripheral circulation
Chemical restraints may involve medication for sedating the agitated elderly patient. This may include a cocktail of mood stabilizers, anti-psychotics, anti-anxiety medication, anti-depressants, and even pain killers. Members of the nursing home staff may illegally increase medication doses in hopes of further sedating a patient. Elderly patients who are being treated with chemical restraints may experience severe mood swings, exhaustion, sleepiness or drowsiness, and lethargy.
Physical and chemical restraint abuse can cause physical harm and mental illness in elderly patients. Restraints may result in the elderly patient being secluded or feeling isolated. The patient may not have enough energy for regular family visits or time with friends. The patient also may experience repeated embarrassment when he or she is unable to get up and use the restroom alone. In an effort to minimize cases of nursing home restraint abuse, the Centers for Medicare & Medicaid Services published a new set of rules in 2007 to further identify proper use of restraints and permission to use restraints.
Elder Restraint Alternatives
According to the 2007 elder restraint report released by the Centers for Medicare & Medicaid, there are rehabilitative alternatives to restraint use in nursing homes. Elder restraint alternatives have proven safer and more effective for elder care. This new focus on rehabilitation emphasizes the patient’s right to choose how he or she is cared for, and it promotes the continued mental health of the elderly patient.
A rehabilitative nurse may assess the elderly patient for causes of confusion to find an elder restraint alternative. The elder assessment may include physiologic, pharmacologic, environmental, and emotional factors within the patient’s life. Triggers for unsafe behavior may be identified, and the rehabilitative nurse is better able to treat the elderly patient by eliminating triggers of confusion altogether.
Elders may be taught to resist impulsivity for a safer nursing home environment. Rehabilitative nurses may cue the patient to stop and think prior to taking actions. This can be accomplished by verbally reviewing the process or steps of an activity before action is taken. By reviewing and rehearsing activities in a safe manner, patients experience an increased independence and a decreased need for elder restraints due to their safer behavior.
Aggression & Agitation
Frequently, a rehabilitative nurse can identify specific triggers that may cause an elderly patient to become agitated or aggressive. There may be specific staff members, or specific patterns of behavior in staff members, that trigger an aggressive response from the patient. By learning what environmental triggers cause the elderly patient to feel angry, the rehabilitative nurse is able to circumvent a need for restraint use by removing these environmental triggers altogether.
Gastmans, C., and K. Milisen. “Use of physical restraint in nursing homes: clinical‐ethical considerations.” PubMed Central. 2006. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564468/>.
Gatens, Cindy. “Restraints and Alternatives.” Association of Rehabilitation Nurses. (2007): n. page. Print. <http://www.rehabnurse.org/pdf/GeriatricsRestraints.pdf>.