Containment in elderly people , specifically mechanical containments such as chemical and pharmacological ones, imply a limitation, retention or impediment in people.

The term containment has a more favourable meaning than “subjection”. That is why we will now define what mechanical restraints are, how they affect and the differences between restraint, holding and restriction.

We also explain what the new manifesto of the Plataforma Nacional sin sujeciones implies, whose signatories are the Comité Español de Representantes de personas con discapacidad (CERMI) and the Fundación Cuidados Dignos led by Dr. Ana Urrutia, among others.

What are containments?

Containment is chemical or pharmacological, physical and mechanical retention . There are generally two criteria to classify them according to the theoretical review of the expert Physiotherapist in Geriatrics Sandra Márquez: the “acceptance of the person to whom it is applied” or the “temporary nature with which it is applied”.

Mechanical Contention CCMM

Mechanical restraint is any material or mechanical instrument used to prevent a person from moving in order to prevent movements that could harm a person around or risk a fall.

However, from the international model of Comprehensive and Person-Centered Care (PCIC) and from the perspective of Interventionist Social Gerontology, this belief is erroneous, since mechanical restraints cause damage that is difficult to reverse. Using restraints to prevent falls is considered malpractice, since the same restraints can also cause ulcers or high-risk falls, in addition to invading a person’s self-esteem and self-concept.

Chemical or pharmacological contents

Chemical or pharmacological containment is the use of medicines that above all have an impact on the Central Nervous System by reducing the need to wander, to attack verbally.

These contentions generate the inhibition of the behaviours considered ”disruptive” in a residential or domiciliary environment , so the AICP considers malpractice actions since they are restrictive, do not facilitate the functionality and autonomy of the person and have serious and complex adverse effects. As defended by Burgueño (2005) and quoted by Márquez (2017), this is the “use of drugs (psychotropic or not) to treat a problem for which there is no better treatment”.

Physical containment

Physical containment refers to a space in which context-restrictive materials are used . They are often used in residences and also in homes to reduce the space in which the person can wander.

It refers to furniture, chairs, tables or any other material from the context in which the person resides that can restrict his or her movement in space.

Difference between containment and restraint

According to Rodríguez (2011) quoted by Márquez (2017) and based on his review in the Working Group of the Ethics Committee of Social Services of the Generalitat de Catalunya, containment is “everything that limits, retains or prevents a person from transgressing a physical, psychological or emotional limit. On the other hand, according to the author, the term restraint directly implies the restriction equivalent to physical binding .

National Platform Manifesto without Attachments

The Manifesto of the National Platform without ties is presented by the Cuidados Dignos Foundation , led by the renowned Geriatrician Ana Urrutia.

This manifesto has been signed by important entities such as Helpage International, Fundación Pilares, Dignitas Vitae, the General Council of Official Medical Associations, UPD and the LARES Foundation. Its objective is to eradicate the practice of physical and chemical restraints in the elderly, people with disabilities and/or with mental health problems and its mission is to raise awareness in society, professionals involved in care and organisations.

Strategies to eradicate containment

In line with the BBPP Good Practices that all Gerontological Resources should exercise with respect to the sexuality of older people and/or those in a situation of dependency or vulnerability, the National Platform without Subjections seeks to guarantee Comprehensive and Person-Centred Care by fighting for the implementation of strategies based on Geriatrics and Gerontology that avoid the use of physical and chemical subjections.

The strategies are developed by professionals of Gerontology and/or Geriatrics (Psychologists, Directors, Occupational Therapists, etc.) always considering the Life History of the person, as well as their motivations and relatively preserved skills.

Care plans, what are they?

The Manifesto of the National Platform without Subjections states that “all entities and organizations that care for elderly people in a situation of dependency or similar, at different levels and in different sectors of care (among which residential centers as well as home care resources) should be obliged to offer to those who care for them the possibility to opt for “care plans” free of physical and pharmacological restraints.

Care Plans are programs of individualized attention commonly known in gerontology as PIAI (Plan Integral de Atención Individualizado). We must also consider that in Home Care these plans are considered to be in development and susceptible to improvement.

Restraint and abuse in the elderly

Any professional, family or personal behaviour that violates the rights of older people is considered inappropriate treatment, therefore mistreatment . We include in such mistreatment not only the violation of intimacy or psychological violation but also the violation of freedom.

Restraint in the elderly is considered abuse, as well as other types such as psychological or physical negligence, physical or verbal aggression, abandonment, etc.

Bibliographic references:

  • Official College of Nursing of Barcelona. Deontological Commission. (2006). “Considerations in the face of physical and/or mechanical containment: ethical and legal aspects”. Barcelona.
  • “How to remove the restraints. A guide to the removal of physical and chemical restraints in health care facilities and at home. Based on the Libera-Ger Standard of the Fundación Cuidados Dignos. Adapted from Rein Tideiksaar, PH. D. President of Fall Prevent, LLC (2005) i Antonio Burgueño, Coordinator of the Untie the Elderly and Alzheimer’s Program at CEOMA.