Study Exposes 'Routine' Use of Restraints on Dementia Patients in English Hospitals
A groundbreaking study has revealed that restrictive practices, including physical restraints and non-consensual sedation, are an embedded aspect of routine ward care for dementia patients in hospitals across England. Conducted by academics at the University of West London, this first-of-its-kind analysis involved 225 days of ethnographic observation across nine NHS wards and more than 1,000 interviews with healthcare professionals.
Widespread Restrictive Practices Uncovered
The report documented numerous examples of restrictive measures being routinely applied to patients living with dementia. These included:
- Raising bedside rails to confine patients to their beds.
- Blocking doors and pathways with furniture to prevent movement.
- Issuing verbal commands, such as instructing patients to sit down or return to bed.
- Implementing physical interventions, notably non-consensual sedation.
Alarmingly, many hospital staff did not perceive these practices as restrictive due to their commonplace use, often justifying them as necessary for patient safety. Staff members expressed uncertainty about alternative methods to care for dementia patients without risking harm to themselves or others.
High Prevalence of Dementia in Acute Admissions
Government figures indicate that up to 50% of all acute hospital admissions involve patients who are also living with dementia. Many of these admissions occur when individuals with dementia require inpatient care following incidents like falls or separate illnesses. This high prevalence underscores the urgency of addressing care standards in hospital settings.
Expert Insights and Patient Experiences
Professor Andy Northcott, lead author of the study and a professor of medical sociology at the University of West London, emphasized the findings. "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," he stated. "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."
Professor Northcott added that while these practices are often intended to be in the patient's best interest, they have significant negative impacts, including agitation, confusion, and distress. Andy Woodhead, a patient with vascular dementia who was hospitalized after a fall, shared his personal experience: "I was confined to the bed and wasn’t able to go to the bathroom, and so had to use a urine bottle. I was made to feel as if I was being a bit of a nuisance."
Calls for Improved Care and Alternatives
The report recommends reducing the use of restrictive practices by encouraging staff to adopt alternatives, such as:
- Supported walking to promote mobility.
- Assisting patients with personal care needs.
- Engaging patients in conversation and actively listening to their concerns.
Paul Edwards, chief nursing officer at Dementia UK, commented on the systemic issues: "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."
NHS Response and Guidelines
An NHS England spokesperson responded to the findings, stating: "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 on how to keep patients safe with the least restrictive practices." This highlights ongoing efforts to balance safety with compassionate care, though the study suggests implementation gaps remain widespread.
