Behind Closed Doors: Involuntary Treatment in Care of Persons with Cognitive Impairment at Home in the Netherlands

Abstract

Involuntary treatment is often used in persons with cognitive impairment receiving home care in the Netherlands. Future research should focus on understanding and preventing inappropriate involuntary treatment in home care.

Professional and family caregivers’ attitudes towards involuntary treatment in community‐dwelling people with dementia

“…The items are grouped into four subscales based on pre‐defined constructs as reported in Hamers et al. (): involuntary treatment in general (20 items), non‐consensual care (15 items), psychotropic medication (13 items) and physical restraints (12 items). Examples of statements are “The safety of people with dementia is more important than the freedom of people with dementia” and “Physical restraints reduce the quality of life of people with dementia”.…”

“…In this article, these types of treatment will be referred to as involuntary treatment. Involuntary treatment is defined as treatment provided by professional or family caregivers without the consent of the client and/or to which the client opposes and can be divided into: (a) non‐consensual care; (b) psychotropic medication; and (c) physical restraints (Hamers et al., ). Non‐consensual care includes all types of care used against the wishes of the client, such as imposing restrictions on daily life choices and activities.…”

“…Most studies reporting on (types of) involuntary treatment focus on physical restraints and/or the use of psychotropic medication and were conducted in the nursing home setting. Literature about the use of involuntary treatment in home care is scarce, especially about non‐consensual care, its effects and the attitudes of professional and family caregivers towards the use of involuntary treatment and non‐consensual care (de Veer, Francke, Buijse, & Friele, ; Hamers et al., ; Scheepmans, de Casterlé, Paquay, Van Gansbeke, & Milisen, ). Hamers et al.…”

“…Hamers et al. () conducted the first study assessing the prevalence of all types of involuntary treatment in PwD living at home and showed that 39% of older people with cognitive impairment experience at least one type of involuntary treatment. In case of involuntary treatment use, non‐consensual care was most commonly used (80%), followed by psychotropic medication (41%) and physical restraints (7%).…”

“…In 74% of the cases, involuntary treatment was used by family caregivers. General practitioners and other healthcare professionals were less likely to use involuntary treatment (Hamers et al., ). Important factors associated with involuntary treatment use were living alone, caregiver burden, ADL dependency, cognitive status and a diagnosis of dementia (Hamers et al., ).…”