Restraint or force: why it's never a solution

Some nights I worry my dad will get up and fall, and I've thought about restraining him to the bed or locking him in his room. I know it sounds bad — what alternatives do I have?

That this thought has crossed your mind doesn't make you a bad person — it makes you an exhausted and scared carer. But it's important for you to know why restraint almost always makes everything worse.

What is known

Restraining a person with dementia (bed rails, belts, doors locked from the inside, sedation "to sleep") increases the risk of serious injuries — people try to climb over rails and fall from a greater height, injure themselves fighting against restraints, or panic. Besides the physical risk, the subjective experience is one of entrapment and terror, and it accelerates decline. That's why international best practices are clear: restraint only in extreme situations, by clinical decision, never as a routine domestic practice.

Alternatives that work

• Low bed (or mattress on the floor next to it), padded mat — if they fall, they fall from a low height.
• Motion sensor or bed pressure sensor that alerts you when they get up (inexpensive and effective).
• Automatic night light to the bathroom — many nocturnal awakenings are to urinate.
• Review the causes of getting up: pain? bladder? hunger? too many naps during the day? sedatives having the opposite effect?
• Secure FRONT door (high lock, alarm) instead of locking the bedroom door — protects without imprisoning.
• If exhaustion is the driving force, the problem to solve is your rest: night support, family rotation, carer respite options.

Talk to the doctor

Repeated nocturnal awakenings deserve assessment (sleep, pain, prostate/bladder, medication). There are solutions — restraint is not one of them.

Sources: Alzheimer's Society (United Kingdom); Alzheimer Europe.