Dangers and Risks of Unsafe Bed Restraints for Dementia Patients

The original goal of bed restraints — like bedside rails, lap belts, and seat trays — was to keep patients safe by preventing falls or wandering that could potentially lead to dangerous injuries.

Now, communities and medical professionals recognize that caring for seniors with dementia requires providing comfort and independence as well as a sense of physical safety. Caregivers must determine which restraint methods encourage safe independence without restricting basic freedoms.

“Restraints are erroneously thought to provide safety for the patient, despite numerous studies demonstrating that restraint use increases the likelihood of infections, physical deconditioning, incontinence, functional decline, and emergence of additional behavioral symptoms,” said Dr. Valerie Cotter in research published in The American Journal of Managed Care. “Therefore, U.S. government and health advocacy groups have instituted laws and guidelines concerning the limited use of restraints.”

In some cases, with permission from the patient’s health care proxy, well-supervised, short-term use of bed restraints can be beneficial for a senior’s health, according to research in the journal Systematic Reviews.

When looking for health care or memory care for a loved one, be sure to understand the dangers and risks of bed restraints for dementia patients.

In this article:

• Restraints as a reaction to dementia behaviors
• Understanding the dangers and risks of bed restraints for dementia patients
• Why restraints have been used for dementia patients
• Safe alternatives to bed restraints for dementia patients
• How memory care facilities, hospitals, and caregivers create compassionate environments
• Additional resources for caregivers

From the moment a loved one receives a dementia diagnosis, learning about the symptoms and stages of this progressive disease should become a top priority for caregivers. Dementia is a general term for cognitive decline that affects memory, reasoning, and thinking abilities. Common dementia behaviors and symptoms include:

• Confusion and forgetfulness
• Aggression
• Disrupted sleep patterns, like insomnia and/or excessive sleepiness
• Wandering
• Delusions and hallucinations

Because of the challenging nature of these behaviors, dementia patients may seem delirious or violent in uncomfortable situations. Caregivers or hospital staff may turn to restraints in an attempt to protect the patient’s safety and the safety of others.

The three types of restraints

• Physical restraints. These can be any device, material, or piece of equipment that deliberately prevents movement.
• Chemical restraints. These are medicines used to subdue behavior rather than treat an illness. Psychoactive medications are commonly used as chemical restraints.
• Environmental restraints. These are less obvious in that they are driven by changes to a person’s surroundings that are effected to restrict mobility.

Bedside rails are the most common type of bed restraint. Side rails can cause injuries as dementia patients try to leave their beds. They may become trapped within, underneath, or between the railings. Patients can work their arms, legs, and even their heads, through the rails in an attempt to escape.

Caregivers or hospital staff tucking in bed sheets too tightly for a patient to leave or purposely placing a tray table in front of a person to limit mobility are also forms of bed restraints.

Restraints applied without true medical need can negatively affect the health of a dementia patient. When their motion is restricted, seniors are unable to care for themselves in simple ways — like using the restroom or stretching their legs.

In addition to physical injuries, the use of restraints on dementia patients can demoralize the senior or worse.

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Physical complications from restraints may include:

• Bed sores and infections due to prolonged bed rest
• Muscle atrophy and difficulty walking
• Increased need for assistance with activities of daily living
• Death by accidental suffocation, strangulation, or heart attack, which can occur when a patient attempts to free themselves

Mental complications from restraints may include:

• Reduced cognitive function
• Increased confusion, as your loved one may not understand why they’re unable to move
• Feelings of dehumanization and isolation

Patients in bed restraints typically receive little to no stimulation or interaction, which can further contribute to delirium, confusion, and depression, according to the book An Introduction to Hospitals and Inpatient Care.

Using bed restraints for dementia patients was once an accepted practice, but studies have shown they’re not safe or effective. Restraints have commonly been used for dementia patients in an attempt to:

• Prevent falls. Because dementia causes difficulties with balance and vision, bed restraints have been used to keep patients immobile. However, research has shown that bed restraints are not an effective method for fall prevention, according to a report from the Alzheimer’s Association.The use of restraints often has an effect opposite the intended purpose of protecting the patient, especially when the intent is fall prevention, according to research published in the British Journal of Medical Practitioners.
• Reduce agitation or aggression. Chemical restraints are frequently used in response to challenging dementia behaviors, as caregivers may interpret these behaviors as a safety threat.De-escalation and redirection, however, are best practices for managing aggressive behaviors in dementia patients, according to research published in The Western Journal of Emergency Medicine. In the event of a life-threatening situation, restraints may be used by trained professionals — but only as a last resort and as a temporary solution.
• Restrict and control movement. Six in 10 people with dementia will have at least one episode of wandering, according to the Alzheimer’s Association. Bed restraints for dementia patients were previously thought of as a way to minimize the risk of wandering. Environmental restraints — like door locks or inaccessible walkers — have also been used to reduce this risk. Restricting motion through bed restraints can produce feelings of fear and helplessness, as well as negative reactions like screaming and fighting. This can cause the situation to become traumatic for loved ones if they don’t understand why their movements are being controlled.

Now that you understand the risks of traditional bed restraints for dementia patients, what steps can you take to help ensure the safety of your loved one?

• Modify the environment. Instead of using side rails or other restraints, try lowering the bed for easier access and reduced fall risk. Adjustable bed frames or specially designed “low beds” can reduce the risk of serious injury.
• Use a bed or door alarm.Bed alarms, like weight-sensing mattresses or foot pads, send caregivers a notification when loved ones are preparing to stand or leave the bed. Door alarms and motion sensors indicate when someone is exiting the house unexpectedly and can be effective for dementia patients who are prone to wandering.
• Create a safety plan for your loved one. When caregivers and hospital staff are aware of a dementia patient’s background and behaviors, they can make a personalized care plan that doesn’t include unnecessary restraint use.

Helping ensure the safety of dementia patients — whether they’re at home, in the hospital, or in a memory care community — is essential. Research and patient experiences have led to the creation of policies and recommendations on restraints in health care settings.

The Nursing Home Reform Act of 1987 sets requirements to protect the health and safety of seniors. The act established that nursing home residents have the right to freedom from physical restraints. In 1995, after reports of serious injuries and deaths related to bed restraints, the U.S. Food and Drug Administration issued an official safety warning on bed rails, requiring a warning label to be printed and posted on rails.

Today, memory care staff are expertly trained in dementia communication and calming techniques that replace mechanical and medical restraints with compassionate responses. Memory care communities also create intentionally designed environments adapted to the needs of dementia patients.

Caring for a loved one with dementia can be both rewarding and challenging. Caregiver support groups offer an opportunity to unwind, release stress, and connect with others who have shared experiences.

Are you wondering if a memory care community may be right for your loved one? Talk with one of A Place for Mom’s trusted Senior Living Advisors about all the options available to you and learn more about the benefits of memory care communities. Their services are free to you and come at no obligation.

Sources

Agens, J. (2010, March). Chemical and physical restraint use in the older person. British Journal of Medical Practitioners.

Talk with a Senior Living Advisor

Alzheimer’s Association. Wandering.

Cotter, V. (2008, January).  The burden of dementia.The American Journal of Managed Care.

Cotter, V. (2005). Restraint free care in older adults with dementia. The Keio Journal of Medicine.

Cotter, V. & Evans, L. (2018). Avoiding restraints in hospitalized older adults with dementia. The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, and the Alzheimer’s Association.

Gastmans, C. & Milisen, K. (2006). Use of physical restraint in nursing homes: Clinical-ethical considerations. Journal of Medical Ethics.

Mirafzali, S., Foust, J., & Siegler, E. (2003). An introduction to hospitals and inpatient care. Springer Publishing Company.

National Consumer Voice for Quality Long-Term Care.Federal Nursing Home Reform Act from the Omnibus Budget Reconciliation Act of 1987.

Richmond, J., Berlin, J., Fishkind, A., Holloman, G., Zeller, S., Wilson, M., Rifai, M., & Ng, A. (2012, February). Verbal de-escalation of the agitated patient: Consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. Western Journal of Emergency Medicine.

Sabangan, B., Katz, B., & Flicker, L. (2016, January 25). Physical restraint use in older people. Australasian Journal on Ageing.

Said, A. & Kautz, D. (2013). Reducing restraint use for older adults in acute care. Nursing.

Sharifi, A., Arsalani, N., Fallahi-Khoshknab, M., & Mohammadi-Shahbolaghi, F. (2021). The principles of physical restraint use for hospitalized elderly people: An integrated literature review. Systematic Reviews.

U.S. Food and Drug Administration. (2017, December 11). HBWS/FCA Frequently Asked Questions (FAQ) on Entrapment Issues.

Yönt, G., Korhan, E., Dizer, B., Gümüş, F., & Koyuncu, R. (2014, March/April). Examination of ethical dilemmas experienced by adult intensive care unit nurses in physical restraint practices.Holistic Nursing Practice.

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