Caring for Dementia

---

Chemical restraints have become an uncomfortable but familiar part of dementia care. Antipsychotics, sedatives, and other medications are often used with the intention of “managing” behaviour, but too often they’re used in situations where behaviour is actually communication, not pathology.

As someone who works closely with families, caregivers and care teams to understand responsive behaviour, I see the consequences of inappropriate chemical restraint use every day: reduced quality of life, increased risk of falls, worsened confusion, and a loss of the person’s autonomy and dignity.

And the research backs this up.

What We Mean by “Chemical Restraints”

Chemical restraints refer to medications used not to treat a diagnosed medical or psychiatric condition, but to control behaviour, reduce mobility, or make a person “easier to manage.”

This often includes:

• Anti-psychotics (Typical and Atypical)
• Sedative-hypnotics
• Benzodiazepines
• Mood stabilizers

These medications can have a place in care — but only when used appropriately, with clear clinical justification, and after non‑pharmacological approaches have been attempted.

What the Research Tells Us

1. Overuse is widespread — especially in long‑term care

A 2024 analysis of more than 12,000 U.S. nursing homes found that over one in five residents was receiving an antipsychotic, often without a diagnosis that would justify it. Some facilities had rates between 50% and 100%, raising serious concerns about resident safety and neglect. 1

2. Staff often feel pressured or unsupported

A 2024 structured literature review found that nurses frequently reported:

• Pressure from families or colleagues to “do something”
• Lack of time or staffing to use non‑pharmacological approaches
• Misunderstandings about what responsive behaviour actually is
• Workplace cultures that normalize medication as the first response 2

These pressures directly contribute to inappropriate prescribing.

3. Communication barriers increase restraint use

A 2025 study from Toronto hospitals found that older adults with dementia who preferred a non‑English language were more likely to receive physical or chemical restraints. This highlights how communication breakdowns — not behaviour — can drive restraint use. 3

Why This Matters

Chemical restraints don’t just “calm” behaviour — they change brain chemistry, blunt emotional expression, and increase risks such as:

• Falls
• Stroke
• Worsening confusion
• Worsening agitation
• Loss of mobility
• Social withdrawal
• Increased mortality

But beyond the clinical risks, there’s a deeper issue:

Chemical restraints silence communication.

Responsive behaviours — agitation, pacing, calling out, resisting care — are often the person’s only way to express:

• Pain
• Fear
• Overstimulation
• Loneliness
• Discomfort with the approach being used
• Boredom
• A need that isn’t being met

When we medicate the behaviour without understanding it, we miss the message.

What We Should Be Doing Instead

1. Start with curiosity, not control

Before reaching for medication, we should be asking:

• What happened right before the behaviour?
• What might the person be trying to communicate?
• Is there pain? Discomfort? Fear?
• Is the environment overwhelming?
• Did we approach too quickly or without explanation?
• Is there a delirium?

2. Use non‑pharmacological strategies first

Evidence‑based alternatives include:

• Adjusting the environment
• Changing communication style
• Modifying care routines
• Providing meaningful engagement
• Addressing sensory needs
• Supporting mobility and autonomy

These approaches take time — but they work, and they honour the person.

3. Use medication only when truly necessary

Chemical restraints should be:

• A last resort
• Time‑limited
• Regularly reviewed
• Clearly documented with rationale
• Paired with non‑pharmacological strategies

Behaviour Support is available

This is where my work comes in.

I support families, caregivers, and care teams by:

• Mapping behaviour patterns
• Identifying triggers and unmet needs
• Understanding what the person is trying to communicate
• Reworking routines and approaches
• Building practical, realistic strategies that actually fit daily life
• Using non-medical interventions to assist in managing behaviour

My role isn’t to replace medication — it’s to make sure it’s not the first or only option.

When we understand the “why” behind behaviour, everything shifts.
Care becomes calmer.
The person feels safer.
And the need for chemical restraints naturally decreases.

If you’re navigating responsive behaviours and want support that goes beyond medication, I can help you build a plan that respects the person, reduces distress, and strengthens connection.

---

RESOURCES

Download, Save, Share below

References

American Geriatrics Society. (2025). Language Preference and Use of Physical and Chemical Restraints Among Hospitalized Older Adults With Dementia. Journal of the American Geriatrics Society.

Jacobs, J., Wei, L., & Slatyer, S. (2024). A Structured Literature Review of Nurses’ Perceptions Concerning the Use of Chemical Restraints Amongst People with Dementia and the Perceived Barriers to Non‑Pharmacological Approaches. SAGE Open.

Schmidt, C. (2024). Nursing Homes Overuse ‘Chemical Restraints’ on Dementia Patients. Undark Magazine.