Moral imperative to treat vulnerable seniors with dignity

Restraint use is widely adopted in hospitals and nursing homes locally in the management of disruptive behaviours of patients suffering from dementia or confusion. It often involves the use of physical implements, such as wrist, ankle or body ties, to ensure patients remain in their beds or chairs.

The intent is to avoid harm inflicted by a patient's disoriented attempts to move out of his confined space, resulting in debilitating falls, or to prevent the removal of devices such as intravenous lines or catheters.

As pointed out by Mr Francis Chan Kum Chew (Nursing homes must highlight pros and cons of restraints; Aug 13), healthcare professionals must evaluate with caregivers the risks and benefits of such interventions.

The irony is that while the primary goal is to prevent harm, the use of restraints has been associated with an increased risk of complications, such as confusion, agitation and pressure sores.

In addition, the use of tube feeding, which often leads to restraint use in those with advanced dementia and other advanced illnesses, has not been proven to prolong survival.

It is gratifying to read the results of the study by Associate Professor Philip Yap (Dementia patients do better without restraints, and Getting to know patients pays off at dementia unit; both published on Aug 13), where a restraint-free system was associated with improved well-being and mobility, with no increase in the rate of falls.

It proves that a restraint-free care system is possible, even in a high-pressured hospital environment.

Given medical evidence against the use of restraints and the ethical concerns surrounding its use, local hospices have a "no-restraint use" policy.

Agitation and restlessness increase at the end of life, affecting more than 80 per cent of patients in the days prior to death.

Such behaviours are distressing to both patients and caregivers but can often be managed with intensive non-pharmacological interventions.

Familial caregivers are also actively engaged in understanding these behaviours and, together with the medical and nursing team, work to provide a safe and reassuring care environment for the patient within the hospice.

Such care is intensive and does require the use of increased medical, nursing and allied health resources, often leading to increased cost of care.

However, there is a moral imperative for us to accord our vulnerable seniors dignity and respect as they reach the end of their lives and we should work towards a restraint-free environment in our care settings.

Allyn Hum (Dr)

Scientific Committee Chair

Singapore Hospice Council

A version of this article appeared in the print edition of The Straits Times on August 18, 2017, with the headline 'Moral imperative to treat vulnerable seniors with dignity'. Print Edition | Subscribe