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Review of "Rights, Risk and Restraint-Free Care of Older People"

By Rhidian Hughes
Jessica Kingsley, 2010
Review by Leo Uzych, J.D., M.P.H. on Sep 27th 2011
Rights, Risk and Restraint-Free Care of Older People

Rights, Risk and Restraint-Free Care of Older People is a book about restraint, focusing on older people.  The book is structured as an edited collection of contributions by professionally distinguished contributors from various countries and drawn from a range of professions.  The Editor, Rhidian Hughes, is a Visiting Senior Lecturer, at Guy's, King's and St. Thomas' School of Medicine, and a Visiting Senior Researcher, at the Institute of Gerontology, King's College, London.  The distinctive custom of the volume is to present discourse, in an academically styled and composed way, notable for being instructively informative, discerningly critical, and expertly opinionated.  In this manner, readers are apprised of a mix of views and perspectives regarding unresolved tensions affecting the contentious area of restraint of older people.  The spotlight cast on the corpus of restraint may potentially engender further worthwhile debate, regarding such tensions.

The textual body is composed chiefly of academic type, relatively esoteric, discourse, pertinent to restraint of older people.

The body of the text is research referenced copiously.  Citations for research materials referenced in a particular chapter are given in a "REFERENCES" section, placed structurally at the chapter's end.

Following the volume's last chapter is a "Select Bibliography", comprised of citations for sundry research materials (alphabetized by author last name, and germane to the volume's substantive composition).

Numerous "case studies" contribute didactically to the text's embodiment.

The text's body is further suffused, instructively, with some "Tables", "Figures", and "Boxes".

Some quoted fragments contribute to the intellectual animation of the textual substance.

Substantively, the writing scythe of the volume's contributors collectively cuts a considerably sized swath across the research field of restraint of older people.

The blade of didactic attention cuts sharply to physical restraint (in Chapter 2); and to drugs misused deliberately ("chemical restraints"), and drugs ("covert medications") administered without the patient's knowledge (in Chapter 3).

The anatomy of Pennsylvania's non restraint approach to psychiatric care and services is dissected and examined adroitly, in Chapter 4.

The primary subject of Chapter 5 is the U.S. nursing home restraint perspective.

The use of restraint to maintain tube feeding is explored gingerly, in Chapter 6.

In Chapter 7, the reader is informed about the "Memory Lane programme", intended to support people with dementia.

Therapeutic interventions relating to companionship are discussed tersely, in Chapter 8.

An examination of  health and safety perspectives, in the context of challenging behavior of older people, is pursued in intellectual earnest, in Chapter 9.

Chapter 10 shines intellectually illumining light on human rights perspectives.

Chapter 11 directs light towards the ethical evaluation of physical restraint.

There is additional discourse, in Chapter 12, relevant to the ethics of restraint use.

The intellectual flashlight, of Chapter 13,  is brightly enlightening concerning the managing of:  delirium, pain, dementia, and depression.

Wandering in people with dementia is studied informatively, in Chapter 14.

Selected research evidence is reviewed expertly, in Chapter 15, regarding the use or removal of restraint in connection with preventing falls.

Penultimate Chapter 16 details efforts to develop an evidence based practice guideline, with respect to the use of physical restraints in nursing homes.

Of special substantive interest, in concluding Chapter 17, is the possible association between reduction in the use of restraint in nursing homes and staff education and training.

Cautious reads may admonish that the area of restraint of older people has been, and remains, contentious; and that the need continues for strongly research supported clinical guidelines, concerning restraint related issues, to help build a strong framework for clinical practice.

Some readers may also observe critically that the panorama of restraint views extends far beyond those presented in the volume.  For example, particular cultural views, and historical views in particular countries, regarding restraint, may be outside the range covered in the volume.

But plainly, the volume's contributors profusely shower a considerable swath of the research field of restraint of older people with the intellectually nourishing rain of informative discourse, discerning criticism, and a plethora of expert opinions and suggestions.  The efforts of the contributors may help nurture further research investigation of this issue ridden field.

The long list of persons who may learn much from this highly instructive volume includes:  patient advocates, psychiatrists, neuropsychiatrists, geriatric psychiatrists, forensic psychiatrists, psychologists, clinical psychologists, psychoanalysts, psychotherapists, cognitive therapists, behavioral therapists, neurologists, neurosurgeons, nurses, psychiatric nurses, rehabilitation nurses, emergency room nurses, gerontologists, geriatric medicine specialists, long term care specialists, physical medicine and rehabilitation specialists, medicolegal specialists, hospice workers, nursing home personnel, hospital administrators, social workers, social scientists, sociologists, medical ethicists, philosophers, public health professionals, occupational therapists, physical therapists, vocational therapists, physiotherapists, recreation therapists, orthopedic surgeons, emergency room physicians,  primary care physicians, pharmacists, pharmacologists, civil liberties lawyers, healthcare lawyers, criminal justice professionals, judges, health regulators, health policy makers, legislators, and risk managers.


© 2011 Leo Uzych


Leo Uzych (based in Wallingford, PA) earned a law degree, from Temple University; and a master of public health degree, from Columbia University.  His area of special professional interest is healthcare.  Twitter @LeoUzych

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