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- W2396796330 abstract "WHY: Use of physical restraints in older adults is associated with poor outcomes: functional decline, decreased peripheral circulation, cardiovascular stress, incontinence, muscle atrophy, pressure ulcers, infections, agitation, social isolation, psychiatric morbidity, serious injuries and death. Older adults with dementia have the highest risk of all patients for being restrained when hospitalized. Impaired memory, judgment, and comprehension contribute to the difficulty these patients have in adapting to the hospital. Patientsmay feel ‘lost’ and afraid, and try to escape or ‘resist’ care, yet language deficits associated with dementia limit their ability to clearlyexpress these concerns. Brain damage associated with dementia also places these patients at risk for delirium or acute confusionalstate, further increasing disorientation and confusion. TARGET POPULATION: Older adults admitted directly from home, nursing home or other non-hospital setting. At particular riskfor restraint use are patients whose behavior (agitation, confusion, exiting the bed unassisted) is judged to be ‘unsafe’, i.e., contributing to falls and interfering with treatment and medical devices. BEST PRACTICE: Best practice supports individualized care that permits nursing the person safely and without physical orchemical restraint. There is no single instrument to assess the meaning of behavioral communication in hospitalized older adultswith dementia. Knowledge about the patient’s usual behavior and function is critical to individualizing care. Standardized screening of cognition and to detect delirium should be done at admission and periodically (See Try This: Mini Mental State Exam; Confusion Assessment Method). ASSESS COMMUNICATION AND BASELINE BEHAVIORS; ASSESS RESTRAINT RISK 4 Assess the message in the patient’s behavior • Ask the patient what she or he needs: Many patients with dementia can still communicate needs. 4 Consult knowledgeable others: Ascertain the patient’s personal and medical history, typical communication style, behavior, daily routines, and abilities. 4 Assess for unmet needs and behavioral changes:" @default.
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- W2396796330 date "2006-10-01" @default.
- W2396796330 modified "2023-09-23" @default.
- W2396796330 title "Avoiding restraints in patients with dementia." @default.
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