Finding Alternatives to Restraining Dementia Patients

Hi Carol - Hope you are well. 

This topic is seems to be so emotional.  How do you decide what is best for a loved one?  It sounds like even with all your bases covered, risk is involved.  This of course is life,  and as it is difficult enough to manage everything that goes along with Alzheimer's and demenita, at least it is still life.  I applaud all those caregivers - family and professional - who do what it takes in the best interest of the patient, while giving themselves a break and realizing, stuff happens, no matter what.

All the best, sue (moderator)

Check out our Alzheimer's Video Library.  As well you may want to readb material from our Caregiver Center.

The topic of restraints to try to prevent falls and injuries of patients with dementia is full of difficult decisions.   It's true, people may complain if their loved one has restraints to prevent a fall, but also, they may complain, or consider starting a lawsuit, if there are no restraints and someone falls, breaks a hip, and possibly dies from the complications.

If a person suffering from dementia stays at home, with a 24 hour caregiver from a caregiver agency, there are ways to minimize the fall risk.  For eight years I worked for caregiver agencies in the San Luis Obispo, California, area, and "stand-by assist" orders were frequent to help prevent falls. Stand-by assist means the caregiver is nearby, within sight or sound, 24 hours a day.  Often the caregiver reads a book, watches TV with the client, or shares other activities with the client in order to remain literally only a few feet away. 

If the fall risk is high, because the person is apt to get up alone from a wheelchair at any time and fall, then the caregiver can "hover" nearby. Of course, there are still times when a caregiver needs step away to visit a restroom, or to prepare a meal. 

The person suffering from dementia would sometimes wish to have some time alone, instead of having a caregiver hovering.  How to preserve quality of life, including a desire for privacy, and reduce the fall risk is a difficult question.  There is the possibility of a lawsuit when there is a fall.

At night the caregiver orders often included having to sleep in a bed in the same room with the person who had dementia, in order to try to prevent a fall if the client tried to get out of bed alone.  Even with a hospita bed with rails up, sometimes people with dementia try to crawl over the rails. When there is 24 hour stand-by assist the caregivers are often rotated every few days so they get relief, because it is so exhausting.

Even with all these precautions, there are falls.  For example, one day when I was in the kitchen preparing dinner, a client with dementia, who used a wheelchair (which of course did not have any restraints as this was home care) got up and fell.  She broke several ribs, had a fight for her life after pneumonia set in, then went to a rehabilitation institute.  When she was at the rehabilitation nursing home I was hired to provide stand-by assist there, too, because once again she kept trying to get up out of the wheelchair or bed alone, and they feared there would be another fall. 

Falls, and how to prevent them, are one of the most difficult aspects of caregiving for someone with dementia.