Exploration of Institutional Dementia Care: Social Engagement and the Use of Physical Restraints

Abstract

Social engagement has been established as an important indicator of quality of life. For individuals with dementia, entering an institution can accelerate their exclusion from the social world of their healthy peers (Kitwood, 1997). This study examined social engagement and physical restraint use in 72 elderly individuals diagnosed with dementia (35 males and 37 females) who were being cared for in a psychiatric in-patient setting. The specific research questions were: 1) how frequently are individuals with dementia constructively engaged, passively engaged, self-engaged, or not socially engaged at all with other individuals in their environment; 2) does social engagement differ across the weekday, evening, or weekend nursing shift; and 3) which individual variables uniquely and jointly predict social engagement? Direct observation of social interactions resulted in the following breakdown: 12% constructive engagement, 5% passive engagement, 38% self-engagement, and 46% non-engagement. A repeated measures ANCOVA indicated engagement did not differ across the three shifts. Hierarchical linear regression analyses were used to show that: 1) greater independence in ADLs predicted constructive engagement but restraint use and behavioral disturbances did not; 2) Physical restraint use predicted self-engagement uniquely and jointly with ADL dependency and behavioral disturbances; and 3) Restraint use predicted non-engagement only when combined with ADL dependency. This study showed that physical restraint use contributes to the social exclusion experienced by individuals with dementia. In addition, individuals with dementia who have the greatest care needs are engaged in the least amount of constructive social interactions.