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Restraint Minimalization in Aged Care and in the Community
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Restraint Minimalization in Aged Care and in the Community

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (11 June 2021) | Viewed by 19552

Special Issue Editors

Dr. Barbara C Wimmer

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Guest Editor
School of Pharmacy and Pharmacology, University of Tasmania, 7005 Hobart, Australia
Interests: quality use of medicines in older people; pharmacoepidemiology; translational research into clinical practice
Dr. Juanita L Breen

E-Mail Website
Assistant Guest Editor
Wicking Dementia Research and Education Centre, University of Tasmania, 7005 Hobart, Australia
Interests: psychotropics; old age mental health; dementia care; health service research; medicolegal and ethical implications of restraint use

Special Issue Information

Dear Colleagues,

Restraint in older people can be defined as equipment or chemicals used to limit the ability to move freely. Nay, Koch and Tirgar (1999) add to the definition that this “does not refer to equipment requested by the individual for their safety, mobility of comfort. Neither does it refer to drugs used—with informed consent—to treat specific appropriately diagnosed conditions where drug use is clinically indicated to be the most appropriate treatment.” Other forms of restraint encompass environmental restraint and psychological restraint.

Given the complexity of the topic, restraint minimisation in older people in the context of patient-centred care is a topic involving a multitude of disciplines. These include advocacy, restraint from an ethical or legal perspective, psychotropic medication use (including antipsychotics and sedatives), nursing, physiotherapy, physician care, public health and policy makers.

Papers addressing these areas are invited in this Special Issue, particularly those combining a high academic standard coupled with a practical focus. Most attention on this topic has focused on institutional settings; however, considering that increasing numbers of older people are supported in the community and that they are frequently looked after by informal care givers, this Special Issue could provide a valuable resource for a variety of target groups. The aim is to provide an interdisciplinary platform for literature on restraint minimalization in residential (or long-term) aged care settings and in the community.

Dr. Barbara C Wimmer
Dr. Juanita L Breen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chemical restraint
  • physical restraint
  • environmental restraint
  • psychological restraint, psychotropic use, antipsychotics, dementia
  • old age mental health
  • aged, 80 and over
  • long term care, nursing home
  • residential aged care
  • community aged care
  • community-dwelling elders

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Published Papers (3 papers)

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Research

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15 pages, 544 KiB  
Article
Interdisciplinary Perspectives on Restraint Use in Aged Care
by Juanita Breen, Barbara C. Wimmer, Chloé C.H. Smit, Helen Courtney-Pratt, Katherine Lawler, Katharine Salmon, Andrea Price and Lynette R. Goldberg
Int. J. Environ. Res. Public Health 2021, 18(21), 11022; https://doi.org/10.3390/ijerph182111022 - 20 Oct 2021
Cited by 5 | Viewed by 4356
Abstract
Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to [...] Read more.
Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint; 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care. Full article
(This article belongs to the Special Issue Restraint Minimalization in Aged Care and in the Community)
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17 pages, 650 KiB  
Article
Human Rights and Empowerment in Aged Care: Restraint, Consent and Dying with Dignity
by Tiffany Jessop and Carmelle Peisah
Int. J. Environ. Res. Public Health 2021, 18(15), 7899; https://doi.org/10.3390/ijerph18157899 - 26 Jul 2021
Cited by 6 | Viewed by 5189
Abstract
The aged care system in Australia is in crisis and people living with dementia are especially vulnerable to breaches of human rights to autonomy, dignity, respect, and equitable access to the highest quality of health care including meeting needs on account of disability. [...] Read more.
The aged care system in Australia is in crisis and people living with dementia are especially vulnerable to breaches of human rights to autonomy, dignity, respect, and equitable access to the highest quality of health care including meeting needs on account of disability. To be powerful advocates for themselves and others, people with dementia and the wider community with vested interests in quality aged care must be informed about their rights and what should be expected from the system. Prior to the Australian Royal Commission into Aged Care Quality and Safety, the Empowered Project was established to empower and raise awareness amongst people with dementia and their families about changed behaviours, chemical restraint, consent, end of life care, and security of tenure. A primary care-embedded health media campaign and national seminar tour were undertaken to meet the project aims of awareness-raising and empowerment, based on 10 Essential Facts about changed behaviours and rights for people with dementia, established as part of the project. Knowledge translation was assessed to examine the need and potential benefit of such seminars. We demonstrated that this brief educational engagement improved community knowledge of these issues and provided attendees with the information and confidence to question the nature and quality of care provision. With the completion of the Royal Commission and corresponding recommendations with government, we believe the community is ready to be an active player in reframing Australia’s aged care system with a human rights approach. Full article
(This article belongs to the Special Issue Restraint Minimalization in Aged Care and in the Community)
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Review

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20 pages, 10020 KiB  
Review
Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review
by Lauren M. Robins, Den-Ching A. Lee, J Simon Bell, Velandai Srikanth, Ralph Möhler, Keith D. Hill and Terry P. Haines
Int. J. Environ. Res. Public Health 2021, 18(7), 3639; https://doi.org/10.3390/ijerph18073639 - 31 Mar 2021
Cited by 18 | Viewed by 9145
Abstract
This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of [...] Read more.
This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions. Full article
(This article belongs to the Special Issue Restraint Minimalization in Aged Care and in the Community)
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