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Restrictive practice in older adult care

James Ridley croppedJames Ridley’s workshop at the forthcoming Restraint Reduction conference is centred on the future of restrictive practices for people with learning disabilities and dementia, looking at the implications relating to this under-reported group.


Supporting older people with dementia and some of the practices employed in the management of behaviours classed as ‘challenging’ has increasingly come under scrutiny. According to the Alzheimer’s Society, up to 75 per cent of people living within residential care have a form of dementia, with half this number being recorded as having some form of behavioural problem. The use of assessments within services to support people with dementia who display behavioural difficulty is limited and, therefore, the use of restrictive practices may be employed without the rigour of thorough justification and review as well as the important comprehensive and person-centred assessment.

People with learning difficulties are living longer and, with this, have a greater potential to develop dementia earlier in their lives. However, when considering this in relation to the over 65s then up to 75 per cent of people with Down’s Syndrome are likely to develop dementia (Rasher, 2005). Older people with learning disabilities are also more likely to develop dementia in later life, when compared to the general population (Department of Health, 2009).

The commitment to the reduction of restrictive practices when supporting people with learning disabilities who do not have dementia is widely reported and researched, however in line with this research and guidance, there is an acceptance that, if these practices are used, then they follow the completion of a comprehensive assessment of the individual, and that the aim is to reduce the use of restrictive practices.

My workshop will explore what is meant by restrictive practices in older adult care provision, what are the risks related to their use and how this impacts on people with learning disabilities. Most importantly it will share ideas related to approaches that can support practitioners to assess the individual in order to protect their rights, while ensuring that the use of unnecessary restrictions is reduced.

James Ridley is Senior Lecturer (Learning Disabilities Nursing) at Edge Hill University. His workshop will take place on the afternoon of 12 November.