Public Health.

Area of Science:

• Gerontology
• Dementia Care
• Hospital Quality Improvement

Background:

• People with dementia are at high risk of restrictive practices during acute hospital admissions.
• Restrictive practice is an under-recognized and under-reported aspect of routine hospital care in the UK.
• Poor data recording in UK hospitals obscures the prevalence and impact of these practices.

Purpose of the Study:

• To explore the use and impact of restrictive practices in the care of people with dementia during acute hospital admissions.
• To identify both visible and hidden forms of restraint within hospital settings.
• To understand the influence of ward culture and staff attitudes on restrictive care.

Main Methods:

• Ethnographic research involving 225 days of observational data collection over 18 months.
• Observations conducted across nine hospital wards in three English regions.
• In-situ interviews with patients and healthcare staff delivering care.

Main Results:

• Restrictive practices are an invisible yet pervasive element of care for all people with dementia in hospitals.
• Both overt restraints (physical, pharmaceutical, legal) and covert restraints (routine practices, staff attitudes, containment cultures) were observed.
• These practices significantly limit patient mobility and increase distress.

Conclusions:

• Restrictive practices negatively impact the well-being and outcomes of people with dementia during hospital stays.
• Current hospital care often confines individuals with dementia to their beds.
• A shift in care cultures and the adoption of alternative approaches are crucial for improving patient experiences and outcomes.