Hospital staff are sometimes confining patients with dementia to bed through controversial “containment and restraint” techniques, new government-funded research reveals.
The findings, paid for by the National Institute for Health Research, reveal that nurses and healthcare assistants are raising the siderails of beds and tucking bedsheets tightly around patients with dementia, reducing their mobility. Others are prevented from getting up by their walking frames being put out of reach or by being sedated with drugs. The techniques are used, say the researchers, because of an exaggerated fear that patients will fall if left to move around the ward freely. The study says the tactics lead to the “dehumanisation” of patients, leaving them angry and highly stressed and worsening their already poor health.
The findings, which have been shared with the Observer, have triggered a fresh row over how the NHS treats people with dementia, who occupy up to half the beds in some hospitals. Dr Eileen Burns, president of the British Geriatrics Society, which represents doctors, nurses and therapists who work with older people, said: “These findings are a huge concern. Sometimes the use of containment techniques is not justified.”
Burns added that too many ward staff perform “a custodial role” towards inpatients with dementia, though she said containment was sometimes needed to benefit the patient’s own health, as when bandages were placed over drips so they cannot be removed.
The research was undertaken by Dr Katie Featherstone, a reader in the sociology of medicine at Cardiff University and Dr Andy Northcott, a lecturer in allied health sciences at De Montfort University, Leicester. They studied in detail how dementia patients in 10 wards of five unnamed hospitals in England and Wales were treated over the course of 18 months. It was funded by the National Institute for Health Research, the Department of Health and Social Care’s research arm.
The researchers found that many dementia patients resist and reject the care provided to them in hospital because they are unhappy at their treatment, sometimes refusing to eat, or removing drips. Many protest at regimented regimes of fixed mealtimes and drug rounds they encounter while being treated for an ailment such as a breathing problem, broken bone or a urinary tract infection.
“At the bedside, staff response to resistance to care was one of containment and restraint. Raising the side rails of the bed or tucking bed sheets in tightly around the patient were both common means to contain a patient within the bed,” the study says. “For those sitting at the bedside, the close placement of the mobile tray table, unreachable walking frames and technologies such as chair alarms were used to contain people and keep them sitting in their bedside chair.”
Featherstone and Northcott conclude that the way staff deal with dementia patients, and the use of containment techniques, is “frequently the trigger of resistance or cause of patient anxiety”, though staff sometimes wrongly blame that on the dementia itself.
Their findings echo previous reports detailing inadequate care received by dementia patients published by Sir Robert Francis and the Care Quality Commission amongst others.
Featherstone told the Observer: “People with dementia on wards generally have early to mid-stage dementia. But part of the problem is that when they are admitted to an acute ward, staff see them as having late-stage dementia, so assume they can’t eat, drink, stand, walk or go to the bathroom independently, even though they still can, and don’t let them keep doing these things. Staff see them as being quite helpless, even though they aren’t.
“When staff react like that, that breeds resentment and high levels of anxiety and resistance to care, for example patients refusing to take their medication, and triggers unhappiness. It’s very isolating and scary for people with dementia to be in hospital. They are a difficult population to handle, and very needy, and I think there’s a strong sense that staff resent them being there,” she said.
Burns said containment was sometimes needed to benefit the patient’s own health, for example, putting a bandage over a drip so it cannot be removed. Lack of staff means nurses do not have the time to talk to patients about their lives or look at old photographs with them to give them mental stimulus, she added.
Between 2010-11 and 2016-17, health spending increased by an average of 1.2% above inflation and increases are due to continue in real terms at a similar rate until the end of this parliament. This is far below the annual inflation-proof growth rate that the NHS enjoyed before 2010 of almost 4% stretching back to the 1950s. As budgets tighten, NHS organisations have been struggling to live within their means. In the financial year 2015-16, acute trusts recorded a deficit of £2.6bn. This was reduced to £800m last year, though only after a £1.8bn bung from the Department of Health, which shows the deficit remained the same year on year.
The Department of Health and Social Care declined to comment on the use of containment and restraint.
A spokeswoman said: “We expect everyone with dementia to be treated with the dignity and respect they deserve. That’s why we invested £50 million to make hospitals and care homes dementia-friendly.
“More than 875,000 NHS staff have undertaken awareness raising activities and we continue to support [NHS] trusts to sign up to the Dementia Action Alliance’s Dementia Friendly Hospital Charter.”