Influence of Freedom of Movement on the Health of People With Dementia: A Systematic Review

Abstract

Background and Objectives To protect residents with dementia from harm, nursing homes (NHs) often have closed-door policies. However, current research suggests a positive influence of freedom of movement, i.e., the right to (decide to) independently move from one place to another, on the health of NH residents with dementia. This systematic review aims to collate, summarize, and synthesize the scientific evidence published to date on the influence of freedom of movement on health among NH residents with dementia. Research Design and Methods Multiple databases were searched up until March 2021. Peer reviewed qualitative, quantitative and mixed-methods studies were included. Health was operationalized using the Positive Health framework, encompassing six dimensions: bodily functions, mental functions and perception, existential dimension, quality of life, social and societal participation, and daily functioning. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Results Sixteen studies were included of good to excellent quality. Compared to closed NHs, freedom of movement in semi-open and open NHs may have a positive influence on bodily functions, mental functions and perception, quality of life and social and societal participation. The influence on daily functioning and on the existential dimension remain unclear. Discussion and Implications Freedom of movement of NH residents with dementia is often studied as part of a larger context in which other factors may contribute to health benefits. More research is therefore needed to unravel the underlying mechanisms of the positive influence of freedom of movement on health.

Promoting activity and mobility in long‐term care environments: A photo‐elicitation study with older adults and nurses

“…However, unit doors were being locked and opened upon request for some residents. The right of a person to decide to independently move from one place to another is conceptualized as freedom of movement (van Liempd et al, 2022). Having freedom of movement in semi‐open (having independent access outdoors within the facilities) or open settings (having access beyond the facilities) can have a positive influence on various physical, psychological and emotional health outcomes of older adults with dementia (van Liempd et al, 2022).…”

“…The right of a person to decide to independently move from one place to another is conceptualized as freedom of movement (van Liempd et al, 2022). Having freedom of movement in semi‐open (having independent access outdoors within the facilities) or open settings (having access beyond the facilities) can have a positive influence on various physical, psychological and emotional health outcomes of older adults with dementia (van Liempd et al, 2022). Instead of protectionism, the benefits, and actual risks and harms of having independent access to outdoor areas should be clearly considered together by professionals, older adults and family (van den Berg et al, 2020).…”

“…Furthermore, regulations could be used to ensure that all older adults can benefit from a long‐term environment that promotes their activity and mobility. The use of closed settings for care should be thoroughly evaluated, as there is evidence of the benefits for older adults living in semi‐open and open long‐term care settings (van Liempd et al, 2022).…”

“…However, unit doors were being locked and opened upon request for some residents. The right of a person to decide to independently move from one place to another is conceptualized as freedom of movement (van Liempd et al, 2022) with dementia should also be entitled to.…”

The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review

“… Notes : a Findings describing physical restraints were excluded from this review. b Article was included in the van Liempd et al (2022) review. c People with dementia not specified, however, 209 of 292 of the nursing home units offered dementia-specific services.…”