Avoiding Restraints in Older Adults with Dementia: Best Practices

Introduction

• Discusses strategies to avoid chemical or physical restraints in older adults with dementia.
• Focus on a case study: Mr. Smith, a 76-year-old male with a fall history, UTI, dehydration, Alzheimer's, diabetes, hypothyroidism, and osteoarthritis.

Patient Information: Mr. Smith

• Admitted after a fall found by his daughter.
• Diagnosed with UTI and dehydration.
• History of Alzheimer's, diabetes, hypothyroidism, osteoarthritis.
• Symptoms: reduced eating, increased lethargy, weakness.
• Initially had a Foley catheter, now on IV fluids and antibiotics.
• Became agitated, leading to use of soft wrist restraints.

Goals for Mr. Smith

• Eliminate physical restraints.
• Ensure patient safety without restraints.
• Improve patient comfort and care.

Observations and Actions

• Vital signs stable; lungs clear; no edema observed.
• Blood sugar was 110; no need for insulin coverage.
• Patient is fidgety and was restless at night.
• Plan to contact daughter and involve her in care decisions.

Avoiding Restraints: Best Practices

• Assessment: Determine if behavior is due to dementia or delirium using confusion assessment.
• Risk Evaluation: Weigh the risks of using vs. not using restraints.
• Therapy Substitution: Switch to oral antibiotics if possible to remove IV restraints.
• Environmental Adjustments: Use low beds, arm sleeves to camouflage IVs, and ensure noise and lighting are appropriate.

The Role of Intent

• Intent determines whether a device is a restraint.
• Important to assess whether the device is protecting from undesired movement.

Alternatives to Physical Restraints

• Use low beds, floor mats, and alarms for fall prevention.
• Use soft mitts or elbow immobilizers as less restrictive restraints.
• Camouflage devices to reduce patient agitation.

Outcomes of Restraints

• Increased agitation, potential injuries.
• Physical restraints can lead to increased risk of falls and injury.
• Permanent bed rest is contrary to best practices.

Interdisciplinary Approach

• Use of interdisciplinary teams in assessment and care planning.
• Engage physical therapists, occupational therapists, pharmacists, and doctors.
• Focus on individualized care involving family.

Communication with Family

• Importance of understanding the patient's baseline behavior.
• Engage family in care decisions and discussions.

Care Plan for Mr. Smith

• Address pain management with acetaminophen and tramadol.
• Assess for potential delirium influences like medications (e.g., Benadryl).
• Social work to provide support and community resources for family.
• Explore home care and physical therapy options.

Conclusion

• The importance of minimizing restraint use and finding safer alternatives.
• Continuous assessment and family involvement are critical in care.
• Availability of resources for nurses to support best practices in dementia care.