Restraints in the elderly: the problem of restraints

Containments in older people, specifically mechanical restraints such as chemical and pharmacological, imply a limitation, retention or impediment in people.

The term containment elicits a more favorable meaning than "restraint." That is why below we will define what mechanical restraints are, how they affect, and the differences between restraint, restraint and restraint.

We also explain what it implies the new manifesto of the National Platform without restraints, whose signatory entities are the Spanish Committee of Representatives of People with Disabilities (CERMI) and the Fundación Cuídos Dignos led by Dr. Ana Urrutia, among others.

• Related article: "Elderly care: how it is produced and what proposals are there".

What are contentions?

Containments are chemical or pharmacological, physical and mechanical retentions. There are generally two criteria to classify them according to the theoretical review of the Physiotherapist expert in Geriatrics Sandra Márquez: the "acceptance of the person to whom it is applied" or the "temporary nature with which it is apply ”.

CCMM Mechanical Containments

Mechanical containment is any material or mechanical instrument used to prevent a person from moving in order to prevent damaging movements a person around or at risk of falling.

However, from the international model of Comprehensive and Person-Centered Care (AICP) and from the perspective of Social Interventional Gerontology this belief is erroneous since mechanical restraints hardly cause damage reversible; Therefore, using restraints to avoid falls is considered bad practice, since the same restraints can also cause ulcers or high-risk falls, in addition to invading the esteem and the self-concept of the person.

Chemical or pharmacological containments

Chemical or pharmacological containment is the use of drugs that mainly have an impact on the Central Nervous System decreasing the need to wander, to verbally attack.

Said contentions generate the inhibition of behaviors considered ‘’ disruptive ’’ in a residential or home environmentTherefore, the AICP considers malpractice actions since they are restrictive, do not facilitate the functionality and autonomy of the person and have serious and complex adverse effects. As Burgueño (2005) cited by Márquez (2017) argues, it is about the “use of drugs (psychotropic or not) to treat a problem for which there is no better treatment”.

Physical restraints

Physical containment refers to a space in which context-restrictive materials are used. They are often used in residences and also in homes to reduce the space in which the person can roam.

It refers to furniture, chairs, tables or any other material of the context in which the person resides that can restrict their movement in space.

Difference between containment and restraint

According to Rodríguez (2011) cited by Márquez (2017) and based on his review in the Working Group of the Ethics Committee of Social Services of the Generalitat de Catalunya, containment is “everything that limits, retains or prevents a person who transgresses a physical, mental or emotional''. On the other hand, according to the author, the term subjection directly implies the restriction equivalent to physically binding.

Manifesto of the National Platform without restraints

The Manifesto of the National Platform without restraints is exhibited by the Dignified Care Foundation, led by the renowned Geriatrist Ana Urrutia.

This manifesto has the signature of important entities such as Helpage International, Fundación Pilares, Dignitas Vitae, the General Council of Official Medical Associations, UPD and the LARES Foundation. Your goal is eradicate the practice of physical and chemical restraints in the elderly, people with disabilities and / or with mental health problems its mission being to sensitize society, professionals who are dedicated to care and organizations.

Strategies to eradicate contention

Aligned with the BBPP Good Practices that every Gerontological Resource must exercise with respect to sexuality in the elderly and / or in situations dependency or vulnerability, the National Platform without restraints seeks to guarantee Comprehensive and Person-Centered Care fighting for taking action of strategies based on Geriatrics and Gerontology thus avoiding the use of physical and chemical restraints.

The strategies are developed by professionals of Gerontology and / or Geriatrics (Psychologists, Directors, Therapists Occupational, etc.) Always considering the life history of the person, as well as their motivations and abilities relatively preserved.

Care Plans, what are they?

The Manifesto of the National Platform without restraints states that “all entities and organizations that serve older people in a situation of dependency or similar, at the different levels and care sectors (including residential centers as well as the resources of home care) should be obliged to offer the people they care for the possibility of opting for "care plans" free of restraints physical and pharmacological.

Care Plans are individualized care programs commonly known in gerontology as PIAI (Comprehensive Individualized Attention Plan). We must also consider that in Home Care (Home Care Service) these plans are considered under development and susceptible to improvement.

• Related article: "Sexuality in Aging: older people also have sex."

Restraints and abuse in the elderly

Any professional, family or personal behavior that violates the rights of the elderly is considered inappropriate treatment, therefore mistreatment. We include in this mistreatment not only the violation of privacy or psychological violation but also the violation of freedom.

Restraints in older people are considered mistreatment, as well as other types such as situations of psychological or physical neglect, physical or verbal aggression, abandonment, and so on.