Oct 19, 2021

Dementia training: Reducing restrictive practices in residential aged care

Dementia Aus op ed

Dementia Australia strongly supports minimising the use of chemical or physical restraint as a way of addressing changed behaviours in people living with dementia in residential aged care. 

Dementia-specific education is paramount to improving the deficiencies in the current system, eliminating the misuse of physical and chemical restraint, and treating people with the respect, dignity and care they deserve.

Despite consistent evidence of their limited efficacy and a high associated risk of adverse effects, psychotropic medications are still widely prescribed for people living with dementia. 

Recent research suggests up to 44% of people living in residential care are receiving antipsychotic medication and only 10% of antipsychotic medication is prescribed appropriately for people living with dementia.[i]

The decision should be made with staff involved and after all other non-pharmacological and therapeutic interventions and approaches have been attempted and proven to be ineffective. 

Staff at all levels across the health and aged care systems should be well-supported to be able to confidently take this approach as the benefits result in less use of medication, less reliance on any form of restrictive practices, and more meaningful engagement with residents.

Providing the aged care workforce with the skills and knowledge to identify unmet needs such as understanding pain relief, and responding appropriately to changed behaviours with individualised, psychosocial interventions will be critical to minimising the use of chemical restraint in residential aged care. 

Education and support for medical practitioners on appropriate prescribing of psychotropic medication will also play a significant role.

This needs to include a strong focus on developing dementia practice leaders who can provide mentoring and coaching within the workplace to support the ongoing application of learning to practice. 

This strong leadership should effectively engage staff, families, carers and people living with dementia when it comes to developing the individual behaviour support plans.

Dementia Australia has long called for a minimum level of dementia education to be mandatory across the aged care workforce. 

Educating the workforce has been the focus of Dementia Australia and the former Alzheimer’s Australia for more than 35 years, through programs such as consultancy and providing a comprehensive suite of education programs, including the award-winning Educational Dementia Immersive Experience (EDIE™) workshop, and through the delivery of the Dementia Essentials program as part of Dementia Training Australia.

Dementia Training Australia also provides dementia-specific accredited and non-accredited education, training, and professional development for aged and health care professionals.

Developed by the Centre for Dementia Learning, the CAUSEd (Communication, Activity, Unwell/Unmet needs, Story, Environment, dementia) model is integrated into all programs as a valuable behaviour problem-solving approach that looks at the best way to problem solve potential triggers that can help to avoid inappropriate use of physical or chemical restraint by staff. 

For all managers in aged care we recommend making use of the Dementia Practice Health Check, which is underpinned by the Aged Care Quality Standards and the expectations of quality care from people impacted by dementia. 

Accessed through a short survey, the tool provides insights for managers as a free online self-assessment. It is designed to highlight strengths and areas for improvement in dementia practice within a care home.

With more than two-thirds (68%) of aged care residents having moderate to severe cognitive impairment, anyone working in aged care must be trained in the fundamentals of quality dementia care.[ii]

To support people living with dementia with the dignity, quality dementia care and respect they deserve and what we all, as a community, expect it is essential dementia care education and training is integral to improve the health, lifestyle and care outcomes for all people impacted by dementia.

Dementia Support Australia also provides additional support services for carers of people living with dementia where behaviours are impacting on care.

We know from our work and broad consultation with people living with dementia, their families and carers, that if we get quality care right for dementia, then there will be quality care for all.

For more information visit dementialearning.org.au, call 1300 DEMENTIA (1300 336 368) or email cdl@dementia.org.au. For Dementia Australia’s position statement on restrictive practices go to dementia.org.au/publications/reports.

[i] MacFarlane and Cunningham, 2021, p.8

[ii] Royal Commission into Aged Care Quality and Safety, Research Paper 8 – International and National Quality and Safety Indicators for Aged Care, 2020, p161.

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  1. The unfortunate reality is that only people living close to a person with advanced dementia knows, really knows about dementia.
    Restrictive practice of medication or physical impediments can’t realistically be abolished. Some sufferers have massive personality changes and occasionally become aggressive towards others and that has to be taken into consideration. We all, either in the community or in a facility have responsibility to those around us..of course the new charter of residents rights doesn’t talk about that but that is considered appropriate in any community… In the community people take medication to assist with depression or aggression, for the greater good the system needs to back off and actually see what occurs without medication.
    Ludicrously having a locked front and back door is now considered as a restrictive practice totally ignoring the fact that families understand that without this security their loved one could and would wander into traffic.
    Rules are great but common sense is paramount.. could someone bring it back please.


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