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Monday, January 10, 2011

Use of Restraints for Alzheimer's Patients


Falls are a difficult subject to address and a difficult situation to control.

By Max Wallack
Alzheimer's Reading Room

Great Grams fell frequently at home near the end of her life. Fortunately, the floors were carpeted and soft, and she was not injured. However, she did fall once, in the hospital, onto a hard floor surface from a high bed. In fact, higher than a high bed, because all the bed rails were up. The hospital called us at night to let us know what had happened.


My questions is, what can be done?

Great Grams was in a room not far from the nurse’s station. They had the bed rails in place, but Great Grams took those as a challenge to climb over. After that fall, Great Grams was strapped into the bed. Imagine being confused, but know you need to use the bathroom (Great Grams wasn’t incontinent until the VERY end), and being tied down so you can’t get up! On the other hand, if she wasn’t restrained, she would have run and fallen. What could they do??

In her stays in some hospitals, the hospital provided a “sitter” to stay by her side all the time. This worked better, but it usually still ended up with Great Grams in restraints, and I’m sure it was very costly for the hospital.

One place, tied her to a chair in the hallway where she could watch the nurses come and go. This worked fairly well, and she was less agitated, but she was still restrained.

In the Dementia facility where Great Grams spent her last 10 weeks, they placed mattresses on the floor around her bed so that she wouldn’t get hurt if she got out of bed. That was a great idea, and it would have worked for many patients. But Great Grams would be running and falling, so they restrained her in a wheelchair whenever she was out of bed.

They did take her out, from time to time, to go to the bathroom and to walk a bit. They tried, but she was a very difficult patient.

Is the solution chemical restraints? The ones that were supposed to work “for sure”, that were provided by hospice, didn’t reduce Great Grams’ getting up all night. They just increased the number of times she fell when she got up. Other chemical restraints just put Great Grams to sleep for 3 days.

Was that a good solution?

Well, it gave the caregivers a chance to regroup, but I don’t think it did much for Great Grams.

One of the best solutions to this problem, if possible, is to keep patients engaged. I thought about this for a long time and as a result PuzzlesToRemember was born.

In my roles as Founder PuzzlesToRemember, I receive lots of feedback on the effectiveness of puzzles and how puzzles engage patients. I know the puzzles we distribute are helping a lot of people. I also know how difficult it was to keep someone as agitated and driven as Great Grams engaged all the time.

Are restraints the right choice?

Max Wallack is a student at Boston University Academy. His great grandmother, Gertrude, suffered from Alzheimer's disease. Max is the founder of PUZZLES TO REMEMBER. PTR is a project that provides puzzles to nursing homes and veterans institutions that care for Alzheimer's and dementia patients.


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Original content Max Wallack, the Alzheimer's Reading Room