Chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate a patient. Medical professionals around the world, including Australia, are treating residents in aged care (including those with dementia) unnecessarily with antipsychotic drugs instead of effectively managing their behavioural and physical symptoms.
Chemical restraints are also referred to as a 'Psychopharmacologic Agent'; Psychotropic Drug. Drugs that are often used as chemical restraints include benzodiazepines, antipsychotics, and Dissociative anesthetics.
A recent report by Alzheimer's Australia - The Use of Restraint and Psychotropic Medication in People with Dementia, provides an evidence-based review of the prevalence of the use of restraint, and the potential negative consequences and legal issues surrounding the use of psychotropic medication and physical restraints in people with dementia.
The report revealed that up to 80% of people with dementia and nearly half of people in residential aged care facilities are receiving psychotropic medications that in some cases are inappropriately prescribed.
Ita Buttrose, the then National President of Alzheimer’s Australia, said that the report raises concerns that in many cases psychotropic medications and physical restraints are the first line of response to the challenging behavioural and psychological symptoms of dementia (BPSD).
Update - May 2015: The wife of one resident overcame enormous obstacles to procure basic information about her husband's medical care in an Australian aged care home. It should not be this difficult to get information:
...Staff gave John an injection of Haloperidol, a powerful anti-psychotic that dropped him to the floor. Afterwards, he was given so-called "chemical restraints" – antipsychotic drugs routinely used to pacify dementia patients in nursing homes ...
... Despite having power of attorney over John's affairs, it took Mrs Sypkens two months to get the nursing home to stop dosing him (with antipsychotics). Only after lodging a Freedom of Information request could she later find out exactly what he had been given ...
Source: Dementia treatment: Stemming the tide of loss - Sydney Morning Herald, 17 May 2015
Do residents who experience dementia benefit from anti-psychotic medication?
Aged Care Crisis draws attention to a UK review (November 2009) into the use of anti-psychotic medications which found that the overprescribing of drugs is linked to 1800 deaths a year. The drugs, developed for treating people with schizophrenia, are sometimes used to calm residents with dementia.
The review found that only a fifth of those on sedative medications were receiving any benefit.
November 12, 2009 — Professor Sube Banerjee, author of a review of UK dementia treatment, says up to 150,000 sufferers are prescribed anti-psychotic drugs unnecessarily
Older adults who take several types of psychotropic medications—such as antidepressants or sedatives—appear more likely to experience falls, according to an analysis of previous studies reported in the November 23 2009 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Research: Use of physical restraints with cognitively impaired nursing home residents
J Adv Nurs. 2004 Feb;45(3):246-51. Hamers JP, Gulpers MJ, Strik W. Associate Professor, Department of Health Care Studies, Section of Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands.
Abstract: AIM: The aim of the study was to examine the prevalence of physical restraint use in cognitively impaired nursing home residents, the manner in which restraints are used, reasons for using them, and relationships between residents' characteristics and use of physical restraints. METHODS: A point prevalence study was conducted on the use of physical restraints among all residents cared for in two Dutch nursing homes and one nursing home unit (n = 265). Data about the nursing home residents and the use of restraints were collected by means of a questionnaire, which was filled in by the nurses. The response rate was 98%. The mean age of residents was 81 years (sd = 8.6), 74% of whom were female. RESULTS: One or more restraints were used with 49% of the residents. The most frequently used physical restraints were bed rails, a waist belt, and a chair with a table. In almost all situations (90%), residents were continuously restrained and restraints were used for longer than 3 months. The most common reason (90%) for use of restraints was to prevent falls. Logistic regression analysis revealed that use of restraints was highly associated with poor mobility, care dependency and risk of falling in the opinion of nursing staff. CONCLUSIONS: The results of this study are comparable with those of other studies. However, since recent studies have reported that physical restraints are inadequate to prevent falls, recommendations are made to re-evaluate critically the use of restraints and to conduct future research into a responsible and safe way of decreasing the use of physical restraints. PMID: 14720241 [PubMed - indexed for MEDLINE]