Can aged care providers use chemical restraint?
“When chemical restraints were used on my mother Christine they prevented me from being able to fully engage with her because she was so drowsy during my visits” Isabelle Burke, Dementia Advocate.
Dementia Advocate, Isabelle Burke’s mother Christine lived with younger onset dementia and was given medication as a form of chemical restraint when she lived in residential aged care.
Despite being prescribed medication to manage her extreme restlessness, Isabelle said she believes there was better ways to manage the problem.
“My mother was extremely restless therefore the best intervention was to encourage her to walk safely around the aged care facility and in the garden,” Isabelle said.
“Being out in the fresh air and amongst the plants was a gentle reminder of the garden she cultivated at her home over 20 years. We took the time, as a family, to accompany our Mum on her walks because it eased her restlessness and allowed her to feel our presence, either holding her hand or just being next to her.
“By addressing her symptoms of restlessness directly we were able to assist Mum to feel calmer and help her to get a better night’s sleep.”
What is chemical restraint?
Chemical restraint, now referred to as a restrictive practice under the Aged Care Act, is the administration of medication to control a person’s movement or decision-making capacity. This includes but is not limited to psychotropic medication, most commonly anti-depressants, anxiolytic/hypnotic agents (primarily benzodiazepines) and antipsychotic medications.
Chemical restraints can be prescribed by a general practitioner /healthcare professional to manage a resident’s changed behaviour. For example, it may be considered if a resident’s behaviour poses potential harm to themselves or others.
Despite consistent evidence of their limited efficacy and a high associated risk of adverse effects, psychotropic medications are still widely prescribed for people living with dementia.
The adverse psychological and physical effects of chemical restraint are well documented and include physical injury and psychological distress, increased confusion, functional decline, an increased risk of stroke and in some cases death.
What conditions govern the use of chemical restraint in residential aged care?
Dementia Australia Executive Director, Advocacy & Research, Dr Kaele Stokes said by law, chemical restraint, or other restrictive practices such as physical restraint or isolating a resident, can only be used by aged care providers under strict conditions.
"From 1 July 2021, providers have had updated and specific responsibilities, outlined in legislation, relating to the use of any restrictive practice in residential aged care. These changes have in part been made because of stories like Isabella and her Mum," Dr Stokes said.
“Approved providers using a restrictive practice must adhere to strict conditions before administering a restrictive practice."
“It must only be used as a last resort. Other options for managing the behaviour must be tried first. If medications/chemical restraint is used, it should be used for the shortest period possible, the person themselves or their substitute decision-maker must give informed consent, and its use must be monitored and regularly reviewed.
"It is extremely important aged care providers and health care providers (who prescribe medications) have a clear understanding of the regulations around the use of restrictive practices.”
Dementia Australia’s position
Dementia Australia strongly supports minimising the use of chemical restraint to address changed behaviour in people living with dementia in residential aged care.
“We need to ask why someone’s behaviour may have changed in the first place,” Dr Stokes said.
“They may have psychological or physical unmet needs that are causing the behaviour, for example, they may be in pain.
“If we can address these unmet needs with non-pharmacological interventions, chemical restraint and other restrictive practices can be largely avoided.”
Critical to minimising the use of chemical restraint in residential aged care is aged care staff having the knowledge and skills to identify unmet needs and to respond appropriately to changed behaviours with individualised, psychosocial interventions.
“Education and support for medical practitioners on appropriate prescribing of psychotropic medication also play an equally significant role in minimising the use of chemical restraint in aged care,” Dr Stokes said.
Dementia Australia’s position on the use of chemical restraint in residential aged care was developed by Dementia Australia's Policy team and is informed by the latest research, Dementia Australia's subject matter experts and consultation with people living with dementia, their families and carers. The statement( 74 kB) is available in full on Dementia Australia’s website.
A band-aid solution
Isabelle maintains her support for psychosocial interventions saying they maintain the dignity of the person living with dementia.
“They [psychosocial interventions] are safer to use than chemical or physical restraints and they have benefits not only to the person living with dementia but also benefits for the family,” Isabelle said.
“This can include more fulfilling social interactions, and benefits to the aged care facility where the person may live such as a less disruptions to community activities, a reduction in wandering into other resident’s rooms and more restful sleep for the resident.
“I see chemical restraint as a band-aid that only seeks to stop any symptoms from occurring and does not address a person's real needs.”
For any questions, information or concerns regarding the use of restrictive practices, including chemical restraint, or on any topic you are concerned about, please call the National Dementia Helpline on 1800 100 500.