In dementia care, our primary goal is always to promote safety without compromising dignity or independence. One area that continues to evolve is how we think about and manage restraints. While once considered protective, restraints—whether physical or chemical—can actually increase the risk of harm and distress. Understanding what constitutes a restraint and why minimizing their use is essential can help caregivers provide better, more person-centered care.
What Is a Restraint?
A restraint is anything that controls or limits a person’s movement, behavior, or access to their body. There are two main types of restraints: physical and chemical.
1. Physical Restraints
Physical restraints are objects or devices that restrict a person’s ability to move freely or access certain parts of their body. Examples include:
• Belts, vests, or wrist ties
• Lap trays or restrictive clothing that the person cannot remove easily
• Chairs designed to prevent standing or movement
• Bed or chair alarms that frighten people into staying still
While these restraints might appear to prevent falls or injuries, they often do more harm than good. They can cause fear, agitation, or even serious accidents when a person with dementia tries to escape them.
2. Chemical Restraints
A chemical restraint involves using medication—usually antipsychotics—to control dementia-related behavior or make care tasks easier for staff. These medications can sedate a person, reducing movement and responsiveness.
However, such medications should never be used simply to calm a person or manage behavior related to dementia unless absolutely necessary for safety reasons. The Centers for Medicare and Medicaid Services (CMS) has required nursing homes to reduce the use of antipsychotics for people with dementia since 2012.
There are times when these medications are appropriate—for example, when a person has a serious mental illness or poses a danger to themselves or others. In those cases, physicians must clearly document why the medication is being prescribed and for how long.
Misconceptions About Restraints
For many years, restraints were believed to promote safety, especially in preventing falls. However, evidence shows that they can actually increase the risk of injury or trauma.
For instance, bed rails were originally designed to keep people from falling out of bed. But for someone with dementia, a bed rail can become a source of danger. A person who doesn’t understand its purpose may try to climb over it, leading to a more severe fall or even entrapment. Without the bed rail, the fall might have been less harmful—or avoided altogether.
In short, restraints can create the illusion of safety while introducing new and serious risks.
Moving Towards a Restraint-Free Approach
The ultimate goal in dementia care is to eliminate the need for restraints by understanding each person as an individual. Compassion, observation, and communication are key. When we connect deeply with the person and respond to their needs—rather than control their behavior—we create a safer, more respectful care environment for everyone.
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