Restraining and sedating dementia patients ‘routine’ in hospitals in England, study finds

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 “embedded aspect of routine ward care”, according to the analysis, with such examples including dementia patients having their bedside rails raised, doors and pathways blocked by furniture, experiencing verbal commands to sit down or go back to bed, and physical interventions such as non-consensual sedation.The report, by academics at the University of West London, involved analysis of 225 days of ethnographic observation across nine NHS wards in England alongside more than 1,000 interviews with healthcare professionals.They also found that many hospital staff did not see these practices as being restrictive due to their routine use throughout NHS wards, with staff questioning how else they could care for patients with dementia to keep them safe without harming themselves or others.Up to 50% of all acute hospital admissions are patients who are also living with dementia, according to government figures. Many of these hospital admissions occur when a patient with dementia may require inpatient care, such as after a fall or separate illness.Prof 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 that looks at the experience of people living with dementia through a hospital admission, and how they are contained at the bedside throughout it.“Once a person with dementia is admitted for anything, they’re essentially expected to stay in bed and there’s a series of subtle to quite overt restrictive practices that are used to ensure that the hospital can manage around them.”He added: “These practices are largely done to be in the patient’s best interest but they have a huge impact on the person they’re done to. The immediate negative impact is that they might not necessarily know where they are, and have the expectation to sit still. Staff don’t like the restriction, they just feel that’s the only way they can manage a person living with dementia, because they feel liable if that person was to have a fall.”The negative impact of dementia patients experiencing restrictive practices ranged from becoming agitated, the report found, to becoming upset and wanting to leave the ward, while not understanding where exactly they are.Andy Woodhead, who has vascular dementia and was admitted to hospital after a fall, said he experienced such restrictive practices by hospital staff. “I was confined to the bed and wasn’t able to go to the bathroom, and so had to use a urine bottle,” he said. “I was made to feel as if I was being a bit of a nuisance.”The report recommended that in order to reduce to use of restrictive practices, staff should be encourage to use alternatives such as supported walking, helping patients with personal care, and listening and engaging patients in conversation.Paul Edwards, chief nursing officer at Dementia UK, said: “It is well known that the care of people living with dementia in acute hospital settings can be variable and can fall short of what patients and 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 people with dementia require.“People living with dementia and their families deserve care that recognises their needs and supports them at their most vulnerable.”An NHS England spokesperson said: “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 NHS has provided staff with guidance and training resources to on how to keep patients safe with the least restrictive practices.”.