Don’t use physical or chemical restraints, outside of emergency situations, when caring for long-term care residents with dementia who display behavioral and psychological symptoms of distress; instead assess for unmet needs or environmental triggers and intervene using non-pharmacological approaches as the first approach to care whenever possible.

Rationale and Comments

BPSD include aggression, agitation, wandering, disruptive vocalizations, anxiety, apathy, hallucinations, and depression. The majority of people living with dementia will experience these symptoms. They result in poor quality of life, more rapid cognitive and functional decline, high risk for abuse, caregiver burden, and tremendous cost to the US healthcare system. In fact, dementia care is among the most costly of diseases including diabetes, cancer, and heart disease; and BPSD account for a staggering 30% of total dementia costs. Despite the high human and dollar costs associated with these symptoms, their treatment continues to challenge practitioners and remains a top research priority in long-term care settings. Because BPSD are often triggered by a change in physical condition, an unmet need or an environment that exceeds the person’s stress threshold, it is important that these triggers be addressed as the first line of treatment rather than resorting to physical or chemical restraint, which carry a risk for adverse effects.

Sponsoring Organizations

American Academy of Nursing

Sources

Expert consensus

Disciplines

Geriatric Medicine
Neurologic
Psychiatric and Psychologic

References

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Kolanowski AM, Litaker M, Buettner L, Moeller J, Costa P. A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents. Journal of The American Geriatrics Society. 2011;59(6):1032-1041.
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