To the 41% of people with dementia that are entered in residences in Spain I know them physically restrained, 67% take drugs (mostly psychotropic) what to them inhibit movement and the 22% are locked up in specific units that prevent them from moving. These are data made public by the doctor Antonio Burgueño, geriatrician doctor Gregorio Marañón Hospital in Madrid and founder of the Desatar program, which leads 20 years working by Elimination of restraints in nursing homes.
This Wednesday, at the Fira Gran de La Farga in L’Hospitalet de Llobregat, an act of the Catalan Association of Directors of Dependency Care Centers (Ascad) was held, which open the debate on fastenings and the deprivation of liberty in residences. To this day, the main reason for hospitalization of those over 65 are the falls, that restraints try to avoid.
The law and the recent instruction of the Prosecutor’s Office stipulate that restraints and restraints in nursing homes are legal, as long as they are prescribed by a doctor. “She is a exceptional measure and must respond to a criterion of strict necessity, authorized by a physician and minimal in its intensity and temporality, as well as transparent. there must be a exhaustive record”, the lawyer explained Marc Molins.
It has been confirmed by the Barcelona disability prosecutor, Julia Arroyo, who has ensured that every six months demands a list of containments of residences in its territory. “I have never found an illegal containment”, has defended. For restraints to be exercised, it is necessary to have the authorization from a relative or whoever holds the guardianship, apart from the medical prescription.
Few resources, more restraints
The truth is that Spain is one of the countries that performs the most restraints in nursing homes, according to Dr. Burgueño. “The resources are limited and that makes it easier to get rid of restraints”, he explained. In most cases, restraints are explained to avoid falls. “More of 1,400 seniors in Spain die every year from falls, it is the main reason for hospital admission of those over 65 years of age”, explained Dr. Inaki Anton, Master’s degree in social gerontology and assessment of bodily harm.
According to Anton’s data, the 2% of the older who fall are admitted to a hospital, and of these, half only survive a year of life after the fall. “Long-term falls generate depression, isolation and anxiety… They limit mobility”, added the doctor, supporter of restraints as a prescribed medical treatment.
The consequences in the elderly
According to doctor Burgueño, who contrary defends eliminating restraints Both physical and pharmacological in Spain, these practices cause significant sequelae in the elderly: pressure ulcers, infections, urinary and fecal incontinence, malnutrition, atrophy and weakness, depression, aggressiveness and apathy, apart from death. In the United States they have caused 1,200 deaths, but the data in Spain are unknown.
“Apart from death, restraints generate more behavior problems and increase the risk of falls”, added Burgueño. “The restraints they are not abuse, but his routine use, for discipline or convenience, yes. One has to curb this excess”, has claimed. In Spain there is a network of 900 restraint-free residences, which represent only 18% of the total centers.
The perspective is that the number of people with dementia or mental illness go boom 12 years ago they supposed 40% of the total of people in nursing homes. Now they are more than 60%. And in the years to come we will exceed 80%”, added Burgueño, for which he has claimed look for alternative methods attention to falls. “One has to empower and train professionals.
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One of the problems that the professionals who have attended the event have commented is that many families ask that their elderly be restrained. “What we do see is that there is a vicious circle: the residences with more deficiencies are the ones that abuse restraints the most, and then with the use of restraints these deficiencies they become chronic and this leads to more restraints”, he lamented.
In this sense, the president of Ascad, Andres Rueda, has defended the necessary financing improvement and the increased ratios in nursing homes. It is a problem that these centers drag from at least a decade in Catalonia. “We need to be understood in our daily praxis. We cannot serve seafood if the Generalitat pays us at the price of white rice: we want to talk about dignity but we must talk about financing and salary improvements”, has claimed. Rueda has also claimed charts of good practices and concrete methodology. “We are going to ask the authorities to worry about this issue because the interpretations are vague”, has settled Rueda.