There’s no need to lock older people into nursing homes ‘for their own safety’ – The Conversation

Extract from an article by Marta Woolford, PhD Candidate and Research Officer at the Department of Forensic Medicine, Monash University

Older people in nursing homes or aged care facilities are often locked up “for their own safety”. But our review shows there’s little justification in most cases for this unfair and unreasonable practice.

In most cases, the chance of older people harming themselves is minimal, so there is no justification for denying them the right to move freely. What can families, facility managers and governments do to give older people back that right?

Wanderers, absconders and elopers

We rationalise locking nursing home doors by arguing that residents are old and frail, don’t know what they are doing, and will otherwise get lost and harm themselves. So, walking out of a nursing home unaccompanied and without telling caregivers is seen as a high-risk activity to be prevented at all costs.

Restraining methods include installing alarmed doors, using physical restraints, as well as pharmaceutical and non-pharmaceutical interventions.

Residents who try to leave unaccompanied and without telling anyone are called “wanderers”, “absconders” or “elopers”. And if people wander, abscond or elope, this counts as an “unexplained absence”.

Unexplained absences happen more often than we realise, with 11% to 31% of US residents living in assisted living or nursing homes reported missing at some time. There is no published data on the proportion of unexplained absences in Australia.

While these absences might be common, our review suggests they might at best not be as dangerous as people think, or at worst, we just don’t have the evidence to tell us how dangerous they are.

Our analysis of nine studies showed most people left by foot, and were found in green vegetation and waterways within 1.6km of the place where they were last seen.

A total of 61 people were injured for every 1000 people with an unexplained absence. And 82 people died for every 1000 people leaving, with extreme temperatures the most common cause of death.

While these figures might sound high, they are likely an overestimate, as unexplained absences from nursing homes were lumped in with those from people living at home in the community.

Also, all of the studies looked at people with dementia, a risk factor for unexplained absence, which may have further overestimated the proportion of people who die after an unexplained absence. This means the high number of deaths doesn’t represent all nursing home residents, who have different and varying levels of cognitive and physical impairment.

SOURCE:  Woolford, Marta. “There’s no need to lock older people into nursing homes ‘for their own safety'” The Conversation, 17 March 2017.

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