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Restraint as a Last Resort

For Agitation Associated with Dementia

​​​​​​​​​​​We all want safe, compassionate care for those we care about, and those we care for. Sometimes safety requires limiting a person’s activity or behaviour. Restraining a person is a last resort in an emergency or when other things haven’t worked. Many healthcare providers, including Alberta Health Services (AHS), have a Restraint as a Last Resort policy.

Many things are stressful and upsetting for people with dementia. It can be embarrassing to get personal care from a care provider. It’s stressful to have trouble understanding or trying to explain things. The goal is to keep the person comfortable, help them to stay as independent as they can, and protect them and others from getting hurt.

Restraint used for agitation associated with dementia includes medicines, and temporarily keeping the person in a room, area, or chair to provide quiet and prevent injury to others. Sometimes gentle physical restraint of arms and legs is needed during care.

Restraint includes many risks:

  • In some people and at some stages in the disease, antipsychotic medicines can make symptoms worse. Sometimes small doses of these medicines may help some people for a limited time. Side-effects can include more confusion, higher risk of falls and pneumonia.
  • More distress and agitation from being kept in a room, area or chair. Being hurt while trying to free themselves.
  • Physical restraint during care can frighten the person and make it difficult for them to trust care providers.

What can be done to use restraint as a last resort?

  • Review and stop unnecessary medicines. Use the lowest dose possible for those that are necessary. Medicine side effects can cause more confusion and add to symptoms such as pain, falls, trouble sleeping, and nausea.
  • Help the person to walk and go to the bathroom, regularly during the day.
  • Look for what physical and social needs they may have like hunger, thirst, or loneliness.
  • Support sleep at night.
  • Help the person to be as independent as possible; involve them in their care.
  • Come back later if the person refuses care; try a different approach, or a different person.
  • Use gentle restraint if needed (holding a hand) and distraction (singing, talking about something the person is interested in).

How Families and Care Partners Can Help

  • Help staff get to know the person, their likes and dislikes.
  • Bring in favourite comfort items or activities.
  • Tell staff if you notice something that upsets the person such as noises, smells, or times of day.
  • Be involved in care activities if helpful for the person, and possible for you.

Helpful conversations for staff, family, and care partners

  • What are the person’s habits, likes, and dislikes?
  • Did they have hobbies, jobs or achievements they like to talk about?
  • What is the best answer to questions they ask often?
  • What helps the person feel calm and relaxed?
  • What type of music do they enjoy listening to?

Current as of: May 1, 2018

Author: Seniors Health Strategic Clinical Network, Alberta Health Services