Restrictive practices are activities or interventions, either physical or pharmacological, that have the effect of restricting a person’s free movement or ability to make decisions. Restrictive practices are overused in residential aged care settings, particularly with people living with dementia. Whilst restrictive practices are used with the intent of ensuring the person’s safety, such practices can negatively impact an individual’s quality of life. Additionally, sleep disturbances in individuals with dementia often exacerbate responsive behaviours and lead to an increased reliance on these restrictive measures.
Dr Suzanne Dawson, a member of the Healthy Ageing Support and Care research program, in collaboration with Professor Stacey George, Professor Kate Laver and Dr Candice Oster from the Caring Futures Institute, is leading a research program that aims to transform care practices for older individuals and those living with dementia.
Dr Dawson’s research program focuses on two key aspects: reducing the overuse of restrictive practices and addressing sleep disturbances in individuals with dementia using weighted blankets.
Caring Futures Institute and Adelaide Primary Health Network (Adelaide PHN) have been working collaboratively on both projects through a partnership which is supported by a joint appointment held by Stacey George, Professor of Healthy Ageing Support and Care. Uniting Communities and SALHN mental health services are also key industry partners.
Overuse of restrictive practices
The first project, funded by the ARIIA Grants program, came from identified needs within the Adelaide PHN Clinical Workgroup to address the overuse of restrictive practices in residential aged care settings. This project, in collaboration with Uniting Communities, will test the implementation of the Safewards program in residential aged care homes.
“We are implementing interventions to enhance aged care staff capacity in providing day-to-day care for individuals with complex needs and minimising the overuse of restrictive practices within residential aged care settings,” Dr Dawson said.
The research team are specialised in restrictive practices, implementation, and dementia care. Other stakeholders in this endeavour include an expert trainer in Safewards, and a lived experience Safewards facilitator.
“The research project is utilising a mixed methods approach to examine the impact of Safewards interventions on the overuse of restrictive practices.” Dr Dawson explained. “This includes collecting and analysing routine data on medication use, incidents of restrictive practices, as well as measures of staff confidence, knowledge, skill levels, and resident wellbeing.”
In-depth insights will also be gathered through focus groups and interviews with staff, residents, and their families.
Weighted Blankets for Sleep Disturbances
The second project, supported by a Dementia Australia grant, focusses on addressing the impact of sleep disturbances among individuals with dementia through the use of weighted blankets.
Dr Dawson’s prior research on weighted modalities, laid the foundation for exploring the potential of weighted blankets as an intervention for improving sleep among individuals with dementia.
“Sleep disturbances significantly affect disease progression in dementia, and weighted blankets are a potential intervention to improve sleep quality, thereby reducing caregiver stress and associated healthcare costs.” Dr Dawson highlighted. “Presently, there are no universally recognised ‘gold standard’ sleep interventions for individuals with dementia.”
The investigation into improving sleep for individuals with dementia involves a pilot randomised controlled trial to determine the effectiveness of weighted blankets as an intervention. This project is in collaboration with the Repat Neurobehavioural Unit, SALHN mental health services.
The data collected will be brought to a co-design workshop. Individuals with lived experience of dementia will collaborate with researchers in developing protocols for introducing the use of weighted blankets across various settings, such as people’s homes and residential aged care.
“This trial strives to identify key factors for successful implementation across diverse care settings, as well as in people’s own homes” Dr Dawson said.
Early responses from participants involved in the studies have been positive.
“The Safewards training sessions have been well-received by staff, and we are progressing with further implementation,” noted Dr Dawson. “Similarly, the enthusiasm from families in the weighted blanket trial signals a strong desire for non-pharmacological interventions.”
“This holistic approach provides a comprehensive understanding of the challenges and opportunities in our pursuit to improve care practices.” Dr Dawson said. ‘Collaborating with various stakeholders enriches our research process, ensuring a more inclusive and impactful outcome.”
The research holds the potential to significantly transform care practices for the elderly and individuals with dementia.
“Through innovative approaches like applying the Safewards model in care settings as an alternative to restrictive measures, and exploring weighted blankets to address sleep disturbances, our research has the potential to profoundly change care for people living with dementia. It could lead to significant policy changes and transform care practices in various settings,” Dr Dawson concluded.