Dementia and the Use of Restraints

Topic: Psychiatry
Words: 2210 Pages: 8


Dementia is a common term for a loss of capacity to recall, think, or make choices that interfere with daily activities. Scientists say that the most prevalent form of dementia is Alzheimer’s disease. Dementia is not a standard characteristic of aging, even though it mainly affects older adults. Auguste Deter, a woman in her early fifties, was the first person to be diagnosed with Alzheimer’s disease, a type of dementia, in 1906. The disorder is named for Alois Alzheimer, the psychiatrist who first identified it. Strange behavior, memory problems, anxiety, disorientation, agitation, and delusions are also symptoms of the disorder. After Deter’s death, Alzheimer’s conducted a brain autopsy and found dramatic shrinkage and varying concentrations in and near nerve cells. Dementia patients may experience severe personality changes or develop delusions. Dementia is often confused with senility or senile dementia, which considers severe mental deterioration to be a natural part of aging when, in fact, it necessitates clinical care. To date, scientists have identified the main types of dementia, its stages, and possible ways to cure or support the body.

However, dementia affects not only the sick person but also the family or those around them. Dementia can be overwhelming for disabled people’s families and caregivers. Physical, emotional, and financial strains can put families and caregivers under much stress, so help from the health, mental, financial, and legal systems is needed. Dementia patients are often denied equal protections and liberties that most enjoy. According to the WHO website, “physical and chemical restraints are used in care homes for older people and acute-care settings, even when regulations are in place to uphold the rights of people to freedom” (World Health Organization, 2020). To maintain the best level of care for people with dementia and their caregivers, a practical and supportive regulatory framework based on globally agreed human rights principles is needed. The purpose of this paper is to analyze details of dementia diseases and to understand what restraints nurses use to provide safeness for patients.

Analysis of Aspects of Dementia

Causes of Dementia

The ability of brain cells to interact with one another is harmed as a result of this injury. When brain cells cannot interact appropriately, it can impair one’s thoughts, actions, and emotions. The brain is divided into several distinct areas, each of which performs a separate function. As cells in a specific region are injured, the region cannot carry out its normal functions. Different forms of dementia are linked to specific types of brain cell loss in specific brain areas. High levels of certain proteins inside and outside brain cells, for example, make it difficult for brain cells to remain intact and interact with one another in Alzheimer’s disease. The hippocampus is the brain’s learning and memory center, and its brain cells are also the first to be harmed. As a result, memory loss is often one of the first signs of Alzheimer’s disease. Although most brain changes that cause dementia are permanent and worsen over time, the following symptoms may improve with medication or resolution of depression, vitamin deficiencies, and excessive alcohol intake.

Diagnosis of Dementia

No one procedure can be used to assess whether or not anyone has dementia. Alzheimer’s disease and other types of dementia are diagnosed based on a detailed psychiatric history, psychological assessment, neurological tests, and the distinct variations in vision, day-to-day function, and behavior associated with each type of dementia. Doctors have a high degree of certainty in determining whether or not an individual has dementia. However, since different dementias’ signs and brain alterations can correlate, it is more difficult to pinpoint the precise form of dementia. According to research, “The prevention of dementia is one of the prevailing public health crises today” (James & Bennet, 2019). A doctor can help diagnose dementia without specifying a form in some cases. Some dementia risk factors, such as age and genetics, are unchangeable. However, experts are also looking at the effects of other risk factors on brain development and dementia prevention.

Types of Dementia

The Vascular Dementia

Vascular dementia is a general term for dementia caused by complications with blood flow to the brain. According to research, “Vascular dementia (VaD) is the second commonest cause of dementia” (Appleton et al., 2017). Vascular dementia can manifest itself in a variety of ways. Multi-infarct dementia and Binswanger’s disease are two of the most common. The most prevalent form of Vascular dementia is multi-infarct dementia. Multi-infarct dementia is caused by a series of strokes, with symptoms that also appear gradually over time. The brain cortex, which is involved in thought, memory, and language, is damaged by strokes. An individual with multi-infarct dementia is more likely than those with Alzheimer’s disease to have more experience in the early stages, and aspects of their personality will remain relatively intact for longer. Extreme depression, mood swings, and seizures are all possible symptoms.

Binswanger’s disorder was once thought to be uncommon, but it is now reconsidered and may be more widespread than previously thought. It is linked to stroke-related improvements, including other Vascular dementias. The white matter deep inside the brain is the part of the brain that is damaged. It is caused by excessive blood pressure, artery thickening, and insufficient blood supply. Early on in the illness, slowness and lethargy, trouble walking, mental ups and downs, and a loss of bladder control are common symptoms. Binswanger’s disease affects the majority of individuals who do or have had elevated blood pressure.

The Frontotemporal Dementia

The term “frontotemporal dementia” refers to dementia caused by gradual damage to the frontal and temporal lobes of the brain. The brain’s frontal lobes regulate mood, social behavior, concentration, judgment, preparation, and self-control. According to research, “FTD is a highly heritable disorder, but almost uniquely within the neurodegenerative disease spectrum, it is neither purely genetic (like Huntington’s disease, HD) nor a mainly sporadic condition (like Alzheimer’s disease)” (Greaves & Rohrer, 2019). Damage can cause changes in personality, emotion, and behavior and a reduction in intellectual ability. The temporal lobes on both sides of the brain are involved in recognizing and interpreting what we hear and see. Damage can make it difficult to recognize objects, as well as interpret and articulate language. Frontotemporal dementia, also known as frontotemporal lobar degeneration, is a form of dementia that affects the brain’s frontal lobes.

The Alcohol-Related Dementia

Alcohol-related dementia is a form of dementia caused by heavy alcohol use. Memory, listening, and other mental processes are all affected. Korsakoff’s syndrome and Wernicke-Korsakoff syndrome are two types of alcohol-related brain damage that can lead to dementia. It is unknown if alcohol has a substantial harmful impact on brain cells or if a deficiency causes damage in thiamine, a B1 vitamin. Nutritional issues common in people who drink heavily on a regular or episodic basis are contributing factors. Vitamin deficiencies, especially severe levels of thiamine deficiency and the direct impact of alcohol on the absorption and use of thiamine, can cause damage to crucial parts of the brain.

Alzheimer’s disease

Alzheimer’s disease is now the most common type of dementia, affecting up to 70% of those who struggle from it. Dr. Alzheimer featured Auguste Deter, a middle-aged lady with dementia and particular brain changes. According to research, “When Auguste Deter died, Alzheimer used the then-new silver staining histological technique to examine her brain microscopically” (Bondi et al., 2017). Alzheimer’s syndrome was regarded as a rare disease affecting individuals under 65 for the next 60 years. Dr. Robert Katzman did not announce that senile dementia and Alzheimer’s disease were the same conditions and that neither was a natural aspect of aging until the 1970s. Alzheimer’s disease can run in families or be intermittent. Alzheimer’s disease can attack humans at any age, although it is most common after 65 and is the leading cause of dementia. A deficiency in one of the genes causes familial Alzheimer’s disease, which is a sporadic genetic disorder. The appearance of mutated genes indicates that the individual may develop Alzheimer’s disease at some point in their lives.

Stages of Dementia

Scientists have identified seven main stages of dementia; from the first to the seventh, the symptoms of dementia gradually appear. However, others may notice apparent problems such as memory loss, loss of concentration, and disorientation in space at the third stage. It all starts with forgetting familiar phrases or familiar places like work or home. Then problems begin that develop over time: not recognizing loved ones, sleep problems, memory loss, paranoia. Dementia progresses in a loved one in a way that is as unique as the person who has it. There is no set path or timetable for moving through the seven levels. However, all forms of dementia develop and wreak havoc over time.

Use of Restraints

Dementia treatment has progressed in recent years, but there are so many things that need to be addressed. Restriction entails more than just restricting a person’s movement; it also entails restricting a person’s liberty. Many people believe it is illegal to limit a person’s voluntary movement or actions deliberately. In certain situations, however, it might be appropriate to practice to ensure the welfare of those in care. Restraint, on the other hand, can never be used under extreme circumstances. It is inappropriate and debilitating to use restraints to control behavior under the expectation that less harm will be done if the individual is confined. It can result in the loss of skills and abilities that are unlikely to return. Low self-esteem and loss of control are both possible outcomes. Relying on restrictions deters caregivers from identifying the source of the person’s pain, contributing to the restraint’s usage.

Restraints have a negative impact on a person’s mental health. Restrained people experience depression, terror, frustration, shame, anxiety, and a sense of helplessness. A person cannot unexpectedly have a strong negative response to restraint, such as yelling, battling, or excessive anger, which may be painful for both the individual and the caregiver. There are numerous different forms of restraints, and many nurses and other healthcare workers may be completely unaware that they are restraining people.

Types of Restraints

Physical Restraints

When a person is physically restrained, he or she is unable to move from a specific location. It could be appropriate if a person with dementia is suffering from a fracture and attempting to move around, but it can never be used to prevent a person from wandering around freely. It is one of the more common forms of constraint, but it is also one of the most severe. The individual can become too cold or too hot, suffer cuts or bruises, or become ill due to the effects.

Mechanical and Electronical Restraints

Mechanical restraint refers to the use of devices such as handrails to keep the person with dementia from falling out of bed, keypads on doors to keep the person with dementia from leaving the device, or rugs that indicate when a man is attempting to exit the area. Technology oversight is a recent type of containment that has received much attention in the media. It involves tagging dementia patients or using cameras to monitor their movements. This form of intervention aims to help the person become as self-sufficient as possible in their surroundings.

Chemical Restraints

In dementia treatment, chemical restraint is a standard model of restraint. People with dementia often feel anxiety, which is referred to as behavioral and psychological signs of dementia. Unfortunately, many patients with dementia have been given antipsychotic drugs to suppress these behaviors in the past. Instead of assessing the behavior and preventing and treating the causes, psychotropic medications only seek to relieve psychiatric symptoms. According to research, “There is no clear proof, however, that psychotropic drugs are effective in treating the challenging behavior of people with dementia” (Willemse et al., 2016). Although these may be suitable for a small number of dementia patients, they are often overprescribed and used as a control due to their strong sedative properties. Drugs should be minimized, and nonpharmacological treatments should be used first to treat dementia.


The Dementia Disease Conclusion

Dementia is a condition in which cognitive ability deteriorates from what can be associated with natural aging; it is typically permanent or gradual. Deterioration of moral regulation, social behavior, or enthusiasm is often associated with and rarely followed by cognitive dysfunction. Dementia is caused by a combination of illnesses and conditions that damage the brain directly or indirectly, such as Alzheimer’s disease or stroke. Dementia is a leading cause of disease and dependency in the elderly around the world. It can be daunting not just for the patients who have it but even for their caregivers and friends. Dementia is often misunderstood and stigmatized, resulting in delays in diagnosis and treatment. Caregivers, families, and society can be affected by dementia in physical, psychological, social, and economical ways.

Use of Restraints Conclusion

People with dementia are often restrained, sometimes unintentionally. Nurses and other service providers must work for dementia patients and help them survive as independently as possible despite their illness. They would collaborate with dementia patients because, after all, they are the experts. The development of enabling spaces, raising concerns about old practices, and empowering people to encourage healthy risk-taking will help people with dementia have a better quality of life.


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