Online retailer Amazon has come under pressure for selling physical restraints on its website that are intended to be used to restrain people who are living with dementia.
Amazon sells several types of physical restraints online, including hand control mittens, belt restraints, upper body jackets, and, perhaps most shockingly, a full body “binding sling”.
The online descriptions of the products say they can be used on patients experiencing drug withdrawal, psychiatric patients, and for those living with dementia.
Physical restraint ineffective and worsens health
The use of physical restraints for older people living with dementia is widely discouraged by the regulators in Australia.
“A restraint-free environment is the recommended standard of care,” the Department of Health states on its website.
Using physical restraint can have serious negative effects on a person’s health, and has been proven not to prevent falls. It has also been shown to be ineffective in calming someone living with dementia who is acting out their frustrations.
“Physical restraint can cause negative physical and psychological outcomes. And there are adverse events or harm associated with the use of physical restraint, such as death, pain, decreased cognitive function, infection, pressure injury development and falls, to name a few,” the website states.
According to the Department of Health, restraint does not prevent falls or falls-related injuries in older people, and it is actually likely to exacerbate behaviours for people living with dementia.
Being able to purchase physical restraints online is “frightening”
Prof Joseph Ibrahim, a specialist in geriatric medicine and aged care safety at Monash University, told HelloCare, “I don’t think people should be able to just go and buy a restraint online.”
“This really needs to be looked into and considered.”
“It flies in the face of what we want to do as a society,” he said.
Prof Ibrahim said the issue raises complex moral and ethical dilemmas. “It’s a frightening thing,” he said.
The lack of regulation around being able to buy restraints online was also of great concern, he said.
“It’s similar to buying medications on the internet. You can run into real problems,” he cautioned.
“It’s a danger for Amazon; should someone die from them, who has the responsibility for that?” he queried.
Physical restraint examined during royal commission
The use of physical restraint has come under the spotlight during the royal commission several times.
Two women revealed to the royal commission their father was tied to his chair for up to 14 hours at a time most days he was in care. His family were not informed of the practice, nor did they give their consent. He was not monitored when the restraints were applied.
Prof Ibrahim told the royal commission that restraining people living in residential aged care “makes no sense”.
“It’s disrespectful and really ought not be allowed,” he said.
“The only possible justification is if there’s an imminent threat to life that you might restrain someone.”
New regulations require operators minimise use of physical restraints
A spokesperson from the Aged Care Quality and Safety Commission told HelloCare, “The Commission is very concerned if any person receiving aged care services is being inappropriately restrained, either through physical means or chemical means.”
In recognition of the fact that physical restraint has been shown to cause harm and does not help residents living with dementia, the government has introduced new legislation to minimise the use of chemical and physical restraints in aged care. The new rules came into effect on 1 July 2019.
Under the new aged care quality standards, under Standard 8 aged care operators must be able to demonstrate it has a framework in place to minimise the use of restraint.
Products remain online, despite Amazon’s assurances of removal
Amazon has reportedly told the United Kingdom’s The Telegraph the products would be removed from sale. However, at the time of publishing, they remained advertised for sale on the online retailer’s site.
“We strongly recommend against buying restraints online”
A spokesperson from Dementia Australia provided HelloCare with the following comment.
“We strongly recommend against the selling and buying of restraints online.
“Physical restraints can have a range of adverse psychological and physical effects and should be a last resort.
“A partnership between the person living with dementia, family carers, their treating doctor, pharmacist and other health and aged care professionals is crucial to providing alternatives to the use of restraints.
“It is best practice to ensure that consultation takes place with the carer and/or legal representative prior to the decision to apply restraint.”
“Physical restraints can have a range of adverse psychological and physical effects. Research has shown that overall physical restraints do not prevent falls and may in some cases cause death.
“There are some situations in which it may be appropriate to use chemical or physical restraint for a short period of time, but clinical guidelines indicate that physical restraints should always be an intervention of last resort.
“There are many interventions that must be considered as first line options when some of the challenging symptoms of dementia may present.
“These options may include administering pain relief, tailoring personal care practices to the individual’s preferences, treating an underlying infection that can result in a delirium, correcting problems with vision or hearing, playing favourite music or working with the family to engage the person in more meaningful and stimulating activities.
“These initiatives may have lasting and positive outcomes, before using restraints is considered.
“The use of restraint in the majority of instances is contrary to providing the best possible health outcomes for people impacted by dementia.”
Restraint must only be used as a last resort
A spokesperson for the Department of Health told HelloCare, “Our community expects that restraint must only be used as a last resort.”
The Department said that from 1 July 2019, new regulations “significantly strengthen” the requirements that apply to the use of physical and chemical restraints in aged care homes.
“There is substantial evidence that shows the negative consequences associated with physical restraint. It may exacerbate behavioural and psychological symptoms of dementia and may place care recipients at risk of adverse events.”
HelloCare contacted Amazon for a comment, but at the time of publishing had not yet received a response. This article was edited on 10 July 2019 to include a comment from Dementia Australia, and on 11 July 2019 to include a comment from the Department of Health.
If anyone is concerned about the use of physical restraint in an aged care facility they can contact the Aged Care Quality and Safety Commission on 1800 951 822.