Dr. Doris Bredthauer
Duration: 01 April 2005 – 31 March 2006
Center: Bethesda Geriatrische Klinik Ulm, Geriatrisches Zentrum Ulm/Alb-Donau
Mentor: Prof. Th. Nikolaus
Research
Participation in the ReduFix Project:
A model program aimed at reducing the physical restraint of care home residents with dementia. A multi-centric cluster-randomized intervention study including a design for waiting-list management; promoted in BFSFJ, Kap. 1702, Title 884 32 (2004).BR>
Problems associated with the use of physical restraints on old people:
Restraints and other mobility-restricting devices are among the most controversial methods used to prevent falls and manage challenging behavior in elderly people with dementia. Yet often they form part of the daily routine in care homes and hospitals (29-41%). Among the most frequently used devices are straps for the body and extremities, geriatric chairs and side rails on beds. They are designed to prevent a voluntary change of position (e.g. standing up and walking). The patient cannot remove them independently.
Such restraints represent a fundamental encroachment on the basic human right to personal freedom. Nursing staff are caught in an ethical dilemma: on the one hand wishing to protect the fragile and cognitively impaired old person from a fall-related injury (“duty of care”), on the other hand breaching that person’s right to autonomy and self-determination as well as dignified contact. As far as is currently known, no existing study confirms the effectiveness of restraints as a means of protecting people from fall-related injury and managing behavioral problems.
On the contrary, the available data suggests that restraints not only increase the danger of direct trauma (lacerations, strangulation, psychic stress), but are associated also with loss of mobility, increased likelihood of falling and injuries resulting from falls, as well as medical complications, deterioration of cognitive functions and an increase in difficult behavior. From previous observation studies, it seems that multifactor programs could potentially reduce the use of restraints without increasing the number of serious injuries from falls, use of psychiatric drugs or staffing. The only controlled study conducted in this area is based exclusively on data from three nursing homes.
Participation and academic process evaluation in “ProjektDEMENZ Ulm”:
This demonstration project aims to optimize care structures and test a care concept for care-dependent dementia sufferers in Ulm (financed by the German Nursing Care Fund under SGB XI § 45c Par. 2, Ulm, Baden-Württemberg, Social Welfare Service).
Aims:
- To establish and develop integrative care provision for dementia sufferers in combination with the gerontopsychiatric qualification of existing and newly created support systems.
- To extend, develop and promote volunteer involvement with affected people.
- To manage the interface /increase the effectiveness of integration.
- To coordinate activities and assistance/case management in line with objectives.
- To achieve a transferable model approach for use in other areas
Clinical Activity and Teaching
Gerontopsychiatric consultation service at Bethesda Geriatrische Klinik Ulm, cooperation in the Bethesda Geriatrische Klinik QM project: “Konzept für die Betreuung Demenzkranker” Direct involvement in the clinic’s internal and in national training programs; lecturer in geriatric medicine for the Q7 interdisciplinary lecture series for medical students at Universität Ulm and in the certified curriculum in Geriatrics (Zercur) of the German Bundesarbeitsgemeinschaft Geriatrie (BAG);
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