UNTIE THE ELDERLY AND DISENGAGE THAT ALARM

In the mid 1980s, a movement began mandating that caregivers “UNTIE THE ELDERLY”. The movement grew, and with the passage of the 1987 Nursing Home Reform Act, the use of physical restraints decreased. Before this movement, it was not uncommon to see any number of nursing home residents restrained in their wheelchairs during the day and in their beds at night.

I remember seeing my first grade teacher as a nursing home resident tied to her bed and also having her bed rails up. That’s called “double restraints.”

A woman obviously happy about being restrained. Picture provided by manufacturer

My own mother was restrained in a nursing home. I remember being shocked when I first saw her in that vest covering the entire front of her upper body. The vest ended in narrow strips of cloth that were tied in the back of her wheelchair. My mother’s response to my question of “why” was a resigned, hopeless shake of her head. The nurse told me it was “doctor’s orders” for her own safety. In those days I did not know better so I didn’t question “the doctor” or the nurse. I know better now and as Maya Angelou says: “We did the best we could. When we knew better, we did better.”

My mother's vest was the style shown in the figure below -- an older style -- than shown here.

Later in rural West Virginia, Ruby, a middle-aged adult child called me in the ombudsman’s office in a sense of panic. Her mother in a local nursing home had called her earlier that morning saying, “Ruby, they’ve got me tied like a dog.”

Some long-known facts about restraints:

Every system in the body is negatively affected through the imposed, prolonged immobility.

The psychological effects of being restrained are obvious to any observer who would put him/herself in the restrained person’s place.

Studies have shown that caregivers relate less frequently to residents who are restrained than to residents not restrained. Restraints, then, mean further isolation

And here’s the kicker: RESTRAINTS DON'TLESSEN INJURIES OR FALLS.

From a recent study: “Despite unambiguous legal regulation and evidence of a lack of effectiveness and safety, physical restraints remain frequently administered in nursing homes, with a recent survey reporting physical restraint rates of more than 20% for U.S. nursing homes, according to background information in the study, which appears in the May 23/30 issue of the Journal of the American Medical Association

One doesn’t see Posey Vests much anymore, though belts and “lap buddies” and things of that nature are too prevalent. The popular restraint used today is the position alarm. They don’t reduce injuries or falls; they don’t keep residents more safe; they have all the negative side effects of any physical restraint -- and then some.

The call today is not to untie our elderly, but to DISENGAGE THAT ALARM!! Tied up, hooked up, the end results are the same.

Transformative Culture Change proves once again that it facilitates happier, healthier outcomes

Fortunately, research continues, fortunately, around Alzheimer’s Disease: cause, cure, and preventative measures. The Chicago Tribune published an article in today’s paper entitled, ““Having Purpose In Life Helps Fight Alzheimer's, Study Finds”

In a nutshell, the research done by the prestigious Rush University Medical Center concludes that persons who have a purpose in life are better protected from health problems, including Alzheimer’s. Persons living with dementia who have purpose in life also maintain a higher cognitive function over time than others living with dementia.
The article includes the researchers’ definition of purpose in life: “the tendency to be intentional, to engage in behaviors that one wants to engage in and thinks are important”

Those behaviors or activities will vary greatly from individual to individual. One may find setting the table an aesthetic, pragmatic and enjoyable task. Another may look forward to feeding and petting the community cat, feeding the fish, walking the dog, caring for favorite potted plants, finishing a special cross stitch, peeling the potatoes for dinner, deciding what the menu for dinner will be, engaging in an evening game of dominos, watching major league baseball on TV,or listening to classical music. It may be in letter writing, or social calls to one’s neighbor, whether that is across the street or across the hall. For all, it is the ability to make choices and to act upon those choices.

The implications for life in retirement and for life in retirement settings is boldly clear. When individuals maintain control over as many choices as possible in their daily life, their life is made better and their brain health is strengthened. When individuals living in an institution continue to engage in their habitual routines, their chosen interests, their accustomed relationships, their life is made better and their brain health is strengthened.

These values stated above are at the core of transformative culture change. As consumers, or consumers-to-be, we should be demanding that this person-directed living be a given mode of operation in any long-term care setting we visit.

For those providing aging services, there is a moral obligation to provide the environment, programs and services that will provide the best practicable results. The amazingly good news is that this approach enhances the bottom line! All this also creates a workplace environment that is humane and healthy with a resulting decrease in employee turnover.

The brief article referenced in this post may be accessed at:

http://www.chicagotribune.com/health/ct-x-alzheimers-purpose-in-life-20120523,0,6856063.story