RESTRICTIVE PRACTICES IN OLDER ADULT CARE.

Transcription

1 RESTRICTIVE PRACTICES IN OLDER ADULT CARE. JAMES RIDLEY SENIOR LECTURER (LEARNING DISABILITIES) EDGE HILL UNIVERSITY

2 AIMS 1. IDENTIFY SERVICE MODELS WHERE RESTRICTIVE PRACTICE IS MORE WIDELY USED IN THE SUPPORT OF OLDER ADULTS. 2. HIGHLIGHT HOW RESTRICTIVE PRACTICES MAY BE DEVELOPED IN RELATION TO VULNERABLE OLDER ADULT GROUPS. 3. HIGHLIGHT THE LEGAL AND ETHICAL FRAMEWORKS WHICH CAN SUPPORT PRACTITIONERS WHEN SUPPORTING OLDER PEOPLE. 4. REVIEW EVIDENCE AND ASSESSMENTS WHICH CAN BE USED TO SUPPORT THE REDUCTION OF RESTRICTIVE PRACTICE.

3 PREDICTABLE ENVIRONMENTS ACUTE PSYCHIATRIC SETTINGS (INCLUDING FORENSIC SETTINGS) SERVICES FOR PEOPLE WITH LEARNING DISABILITIES AND CHALLENGING BEHAVIOUR OLDER ADULT SERVICES WHERE INDIVIDUALS MAY BECOME AGITATED OR CONFUSED. (DOH 2014)

4 REACTIVE MANAGEMENT CLINICIANS ARE COMMONLY ASKED TO INTERVENE IN SITUATIONS OF ACUTE DISTURBANCE IN CARE PLACEMENTS. INTENSIVE AND HIGH-QUALITY SUPPORTIVE OR BEHAVIOURAL INTERVENTIONS MAY NOT BE AVAILABLE. DEMAND IS USUALLY FOR IMMEDIATE ACTION TO MANAGE BEHAVIOUR IN ORDER TO AVOID PLACEMENT BREAKDOWN. (GLOVER ET AL, 2014)

5 RESTRAINT! THE INTENTIONAL RESTRICTION OF A PERSON S VOLUNTARY MOVEMENT OR BEHAVIOUR COUNSEL AND CARE (2002). RESTRAINT is a RESTRICTIVE PRACTICE

6 RESTRICTIVE PRACTICE RESTRICTIVE INTERVENTIONS CAN DELAY RECOVERY, AND CAUSE BOTH PHYSICAL AND PSYCHOLOGICAL TRAUMA TO PEOPLE WHO USE SERVICES AND STAFF. (DEPARTMENT OF HEALTH, 2014)

7 FORMS OF RESTRICTIVE PRACTICE CHEMICAL MECHANICAL PHYSICAL PSYCHOLOGICAL (RCN, 2008)

8 RISK GROUPS PEOPLE WHO ARE DIFFICULT OR THREATENING. PEOPLE WHO ARE NON-CONFORMING, THEREFORE CAUSING A MANAGEMENT PROBLEM PEOPLE WHO ARE LESS PHYSICALLY OR MENTALLY ABLE CSCI (2007)

9 WHAT IS DEMENTIA. DEMENTIA DESCRIBES A SET OF SYMPTOMS THAT MAY INCLUDE; MEMORY LOSS, DIFFICULTIES WITH THINKING, PROBLEM-SOLVING OR LANGUAGE. A PERSON WITH DEMENTIA MAY ALSO EXPERIENCE CHANGES IN THEIR MOOD OR BEHAVIOR. DEMENTIA IS CAUSED WHEN THE BRAIN IS DAMAGED BY DISEASES, SUCH AS ALZHEIMER S DISEASE OR A SERIES OF STROKES. ALZHEIMER S DISEASE IS THE MOST COMMON CAUSE OF DEMENTIA BUT NOT ALL DEMENTIA IS DUE TO ALZHEIMER S. THE SPECIFIC SYMPTOMS THAT SOMEONE WITH DEMENTIA EXPERIENCES WILL DEPEND ON THE PARTS OF THE BRAIN THAT ARE DAMAGED AND THE DISEASE THAT IS CAUSING THE DEMENTIA. ALZHEIMER S SOCIETY (2014)

10 PREVALENCE COMPARISON. Comparative Rates of Dementia - Down s syndrome, Learning disabilities, General Population DS LD GP Cooper, personal communication British Psychological Society, Royal College of Psychiatrists, 2009

11 ASSESSMENT DIFFICULTIES DIFFICULTIES IN THE ASSESSMENT OF DEMENTIA FOR PEOPLE WITH LEARNING DISABILITIES; ALREADY HAVE UNDERLYING COGNITIVE DEFICITS AND IMPAIRED LIVING SKILLS. PRONE TO HEALTH PROBLEMS MIMIC SYMPTOMS. LACK OF COMMUNICATION SKILLS TO REPORT ON SYMPTOMS EXPERIENCED. CARERS CHANGE FREQUENTLY LACK OF DETAILED KNOWLEDGE OF CHANGES IN FUNCTIONING GENERIC ASSESSMENTS CANNOT BE USED DUE TO THEIR LEARNING DISABILITY. THEREFORE IT IS VERY DIFFICULT TO IDENTIFY ANY COGNITIVE CHANGES DUE TO DEMENTIA, FROM A ONE OFF ASSESSMENT E.G. MINI MENTAL STATE. (JANICKI, DALTON, (1999)

12 DIAGNOSTIC OVERSHADOWING BOTH PEOPLE WITH LEARNING DISABILITIES AND PEOPLE WITH MENTAL HEALTH PROBLEMS EXPERIENCE DIAGNOSTIC OVERSHADOWING.

13 WHAT ARE THE BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD). BPSD INCLUDES; AGITATION, ANXIETY, IRRITABILITY AND MOTOR RESTLESSNESS, OFTEN LEADING TO BEHAVIOURS SUCH AS WANDERING, PACING, AGGRESSION, SHOUTING AND NIGHT-TIME DISTURBANCES, PSYCHOSIS, AND, MOOD DISORDERS. OTHER SYMPTOMS INCLUDE SEXUAL DISINHIBITION, EATING PROBLEMS AND ABNORMAL VOCALIZATIONS (SHOUTING, SCREAMING AND DEMANDING ATTENTION, ETC). BALLARD, O BRIEN, JAMES, SWANN, (2003),

14 MANAGEMENT OF BPSD. Restraint amongst the institutionalised elderly with dementia and problem behaviour is inevitable Testad, Aasland, Aarsland (2005)

15 HOW TIMES CHANGE!!!!!! CHALLENGING BEHAVIOUR IS AN INEVITABLE ASPECT OF DEMENTIA, (STOKES AND GOULDIE, 1990) CHALLENGING BEHAVIOUR IS NOT AN INEVITABLE CONSEQUENCE OF THE CONDITION. KERR (2007)

16 MENTAL CAPACITY ACT, 2005 SECTION 6: RESTRAINT IS ONLY PERMITTED TO; PREVENT HARM, MUST BE PROPORTIONATE.

17 HUMAN RIGHTS BASED APPROACH. A HUMAN RIGHTS BASED APPROACH OFFERS ONE METHOD FOR FACILITATING POSITIVE RISK MANAGEMENT. WHITEHEAD, GREENHILL, CARNEY, (2009)

18 FAIRNESS RESPECT EQUALITY DIGNITY AUTONOMY FREDA PRINCIPLES

19 HUMAN RIGHTS RISK SCREEN. USED AS A PROMPT TO QUESTION WHETHER APPROPRIATE INTERVENTIONS ARE IN PLACE. GREENHILL, WHITEHEAD, CARNEY, (2009)

20 REDUCING RESTRICTIVE PRACTICES. HEALTH NEEDS ASSESSMENT HEALTH ACTION PLANS LIFE STORIES PERSON CENTRED PLANS BEHAVIOURAL ASSESSMENTS PAIN MANAGEMENT. ENVIRONMENTAL ASSESSMENT. MEDICATION REVIEWS CAPACITY ASSESSMENTS COMMUNICATION ASSESSMENTS. RIDLEY AND JONES (2012

21 CONCLUSION. IF ALL YOU HAVE IN YOUR TOOL BOX IS A HAMMER, ALL THE WORLD LOOKS LIKE A NAIL. ABRAHAM MASLOW

22 CONTACT DETAILS JAMES RIDLEY (SENIOR LECTURER (PRE-REGISTRATION NURSING)) EDGE HILL UNIVERSITY ST HELENS ROAD ORMSKIRK LANCASHIRE L39 4QP TEL; ;

23 REFERENCES BALLARD, C, O BRIEN, J, JAMES, I, SWANN, A, (2003), DEMENTIA; MANAGEMENT OF THE BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS, OXFORD UNIVERSITY PRESS, OXFORD. BRAUN, J, LIPSON, S, (1993), TOWARD A RESTRAINT FREE ENVIRONMENT; REDUCING THE USE OF PHYSICAL AND CHEMICAL RESTRAINTS IN LONG TERM AND ACUTE CARE SETTINGS, HEALTH PROFESSION PRESS, SYDNEY. BRITISH PSYCHOLOGICAL SOCIETY, ROYAL COLLEGE OF PSYCHIATRISTS, (2009), DEMENTIA AND PEOPLE WITH LEARNING DISABILITIES, BPS/RCP, LONDON BURNARD, P, CHAPMAN, C, (2005), PROFESSIONAL AND ETHICAL ISSUES IN NURSING, BALLIERRE TINDALL, EDINBURGH. BOWLES, L, (1996), HOW MUCH SHOULD PATIENTS BE TOLD ABOUT THEIR MEDICATION, BRITISH JOURNAL OF NURSING, 5, 3, , CITED BY; CARESS, A, L, (2003), GIVING INFORMATION TO PATIENTS, NURSING STANDARD, 17, 43, CARE QUALITY COMMISSION (NEE COMMISSION FOR SOCIAL CARE INSPECTION), (2007), RIGHTS, RISKS AND RESTRAINTS; AN EXPLORATION INTO THE USE OF RESTRAINT IN THE CARE OF OLDER PEOPLE, CSCI, NEWCASTLE UPON TYNE. CARESS, A, L, (2003), GIVING INFORMATION TO PATIENTS, NURSING STANDARD, 17, 43,

24 REFERENCES COUNSEL AND CARE, (2002), SHOWING RESTRAINT; CHALLENGING THE USE OF RESTRAINT IN CARE HOMES, COUNSEL AND CARE UK, LONDON. DEPARTMENT OF HEALTH, (2001), VALUING PEOPLE, DOH, LONDON. DEPARTMENT OF HEALTH, (2014), POSITIVE AND PROACTIVE CARE: REDUCING THE NEED FOR RESTRICTIVE INTERVENTIONS, HMSO, LONDON DISABILITY RIGHTS COMMISSION, (2006), EQUAL TREATMENT; CLOSING THE GAP, DISABILITY RIGHTS COMMISSION, LONDON HOME OFFICE (2005), MENTAL CAPACITY ACT (2005), HMSO, LONDON. HOUSE OF LORDS, HOUSE OF COMMONS, JOINT COMMITTEE ON HUMAN RIGHTS, (2008), A LIFE LIKE ANY OTHER? HUMAN RIGHTS OF ADULTS WITH LEARNING DISABILITIES, SEVENTH REPORT, HMSO, LONDON. GASHMANS, C, MILISEN, K, (2006), USE OF PHYSICAL RESTRAINT IN NURSING HOMES; CLINICAL ETHICAL CONSIDERATIONS, JOURNAL OF MEDICAL ETHICS, 32, GREAT BRITAIN. HUMAN RIGHTS ACT 1998: ELIZABETH LL. CHAPTER 42. (1998). LONDON: THE STATIONERY OFFICE JANICKI, M, DALTON, A, (1999), DEMENTIA, AGING, AND INTELLECTUAL DISABILITIES: A HANDBOOK, ROUTLEDGE, NEW YORK. KERR, D, (2007), UNDERSTANDING LEARNING DISABILITY AND DEMENTIA, JESSICA KINGSLEY, LONDON.

25 REFERENCES LEADBETTER, D, (2002), GOOD PRACTICE IN PHYSICAL INTERVENTION, IN ALLEN, D, (ED), ETHICAL APPROACHES TO PHYSICAL INTERVENTIONS, BILD, P OSMAN, L, ET AL, (1994), REDUCING HOSPITAL ADMISSION THROUGH COMPUTER SUPPORTED EDUCATION FOR ASTHMA PATIENTS, BRITISH MEDICAL JOURNAL, 308, 6928, , CITED BY; CARESS, A, L, (2003), GIVING INFORMATION TO PATIENTS, NURSING STANDARD, 17, 43, RIDLEY, J, JONES, S, CLAMPING DOWN ON THE SE OF RESTRICTIVE PRACTICES, LEARNING DISABILITY PRACTICE, 15, 2, ROLLINS, M, (2006), SAFETY ISSUES SURROUNDING THE USE OF BEDRAILS, NURSING OLDER PEOPLE, 17, 10, ROYAL COLLEGE OF NURSING, (2008), LETS TALK ABOUT RESTRAINT: RIGHTS, RISKS, AND RESPONSIBILITIES, RCN, LONDON STOKES, G, GOULDIE, F, (1990), WORKING WITH DEMENTIA, WINSLOW PRESS, BICESTER. TESTAD, I, AASLAND, A, M, AARSLAND, D, (2005), THE EFFECT OF STAFF TRAINING ON THE USE OF RESTRAINT IN DEMENTIA: A SINGLE-BLIND RANDOMISED CONTROLLED TRIAL, INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 20,

26 REFERENCES TINETTI, M, ET AL, (1994), A MULTI-FACTORIAL INTERVENTION TO REDUCE THE LIKELIHOOD OF FALLING AMONG ELDERLY PEOPLE LIVING IN THE COMMUNITY, NEW ENGLAND MEDICAL JOURNAL, 331, 13, , CITED BY; KELLY, A, DOWLING, M, (2004), REDUCING THE LIKELIHOOD OF FALLS IN OLDER PEOPLE, NURSING STANDARD, 18, 49, WATSON, R, (2001), RESTRAINT; ITS USE AND MISUSE IN THE CARE OF OLDER PEOPLE, NURSING OLDER PEOPLE, 13, 3, WHITEHEAD, R, CARNEY, G, GREENHILL, B, (2009), ENCOURAGING POSITIVE RISK MANAGEMENT; SUPPORTING A LIFE LIKE ANY OTHER USING A HUMAN RIGHTS BASED APPROACH, IN, LOGAN, C, WHITTINGTON, R (EDS), SELF-HARM AND VIOLENCE: BEST PRACTICE IN MANAGING RISK,. WORLD HEALTH ORGANISATION, (1986), DEMENTIA IN LATER LIFE; RESEARCH AND ACTION; REPORT OF THE WHO SCIENTIFIC GROUP ON SENILE DEMENTIA, WHO, GENEVA, CITED BY; BALLARD, C, O BRIEN, J, JAMES, I, SWANN, A, (2003), DEMENTIA; MANAGEMENT OF THE BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS, OXFORD UNIVERSITY PRESS, OXFORD.

27 Useful Reading Abbey, J., Piller, N., Bellis de, A., Esterman, A., Parker, D., Giles, L. & Lowcay, B. (2004) The Abbey pain scale: a 1-minute numerical indicator for people with end stage dementia. International Journal of Palliative Nursing, 10, Deb S., Clarke D. & Unwin G. (2006) Using medication to manage behaviour problems among adults with a learning disability: Quick Reference Guide (QRG), University of Birmingham, MENCAP, The Royal College of Psychiatrists. Department of Health (2008) End of Life Strategy; Promoting high quality care for all adults at the end of life. TSO (The Stationery Office). Dodd, K., Kerr, D. & Fern, S. (2006) Down s Syndrome and Dementia Workbook for Staff. Down s Syndrome Association. Down s Syndrome Association. Dodd, K., Turk, V. & Christmas, M. (2002) Resource Pack for carers of adults with Down s Syndrome and dementia. BILD Publications. Evenhuis, H.M., Kengen, M.M.F., & Eurlings, H.A.L. (2007). Dementia Questionnaire for People with Learning Disabilities (DLD). UK adaptation. Harcourt Assessment. Holland, A.J. (2004) Down s Syndrome and Alzheimer s Disease: A guide for Parents and Carers. Down s Syndrome Association.

28 Useful reading. Kerr, D. (1997) Down s Syndrome and dementia: a practitioner s guide. Venture Press. Kerr, D. (2007) Understanding Learning Disability and Dementia: Developing Effective Interventions. Jessica Kingsley Publishers. Kerr, D., Cunningham, C. & Wilkinson, H. (2006) Responding to the Pain Needs of People with a Learning Disability. York Publishing Services. Prasher, V.P. (2005) Alzheimer s Disease and Dementia in Down s Syndrome and Intellectual Disabilities. Radcliffe Publishing. Thomas, K. & Department of Health (2005) Gold Standards Framework. Department of Health. Watchman, K. (2006) Keep Talking about dementia: Information for Siblings and professionals about Down s Syndrome and dementia. Scottish Down s Syndrome Association.

29 Useful websites (AGEING WELL PROJECT)

30