living your best to the end

Alzheimer’s and Restraints: Benefits and Risks

To restrain or not to restrain Until I met Sylvia Davidson, the word restraints scared the bejesus out of me, conjuring up straight jackets, handcuffs, ropes tape over mouth and struggling terrified restrainees. (clearly, I’m watching too many crime shows). That was B-S: Before Sylvia – Advanced Practice Leader, Geriatrics at Toronto Rehab and past President Ontario PsychoGeriatric Association. In Sylvia, I found a woman whose first concern is what’s best for the patient. Considering her patient population has dementia, gaining an understanding of the patient, to determine what’s best for them, is not all that dissimilar to a crime investigation – where the goal is to gain trust towards getting the truth. More than technical skills, this requires an emotional connection. “Nurses here are schooled in the 3 D’s: Delirium, Depression, Dementia. It’s our job to figure out who and how he/she was before dementia.” The Restraints Minimization Act describes when they are to be used: “for the prevention of serious bodily harm to a patient or to others”. There are three categories of restraints: Chemical Environmental Physical Before restraints of any kind are considered, there has to be consent – usually from the surrogate/substitute decision-maker, who is made aware of risks and benefits, a couple of examples of which are: Benefits: facilitating activities, calming and preventing harm. Risks: becoming more agitated, not being able to get to the bathroom (incontinence), being more unsteady afterwards. With consent, a comprehensive assessment process – with the family and the patient at its center. “Family members are so important because they knew this person before dementia set in. If we learn...