CHARE-GD II Subproject 5: The Use of Closed Doors in Dementia Wards. Comparing Cultural and Moral Perspectives as ell as Contexts for Mutual Learning in a Cross-Border Region

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Background of the project

Nursing home residents with advanced dementia require intensive care and protection. In order to do this appropriately and safely, care homes sometimes take measures that restrict residents' freedom of movement. For example, a resident may no longer be allowed to go outside independently or the environment may be designed in such a way that residents can no longer find their way out properly. These measures can raise ethical questions if they conflict with the residents' human rights and quality of life. After all, in principle, everyone is free to go wherever they want.

Freedom of movement for nursing home residents with advanced dementia. A literature review of measures and ethical considerations

What is the literature review about?

In this literature review, we have examined what is known in the scientific literature to date about the measures that care homes take to organise residents' freedom of movement and what ethical considerations underlie them. We also analysed whether the gender of the residents plays a role in this. We found a total of 30 studies published on this topic in various Western countries. Most of the studies took place in a so-called "closed-door environment", i.e. the residents cannot go outside independently.

What measures are known?

Various measures are mentioned to organise the freedom of movement of care home residents. To prevent residents from leaving the home unseen, some homes use a signalling system. There are also care homes that camouflage the exit doors by covering the walls with decorations. To give residents with dementia more freedom of movement, some homes use GPS trackers so that a resident who goes outside can be found. There are also homes that have created walking paths in the building so that residents can walk independently in a setting that is perceived as safe. Several care homes offer residents free access to an indoor garden so that they can go outside at any time. Increasing attention is being paid in architecture to how residents with dementia can find their way around the building more easily.

What are moral considerations?

From a moral point of view, it's always about the reliability of the technology and the availability of staff. This is not always optimal, so it is not always possible to provide the desired level of safety. There is also a debate about whether it is morally acceptable to conceal the outcome. This may conflict with the dignity of the residents. There are no studies that focus specifically on the gender-specific needs of residents in relation to freedom of movement measures, although there may be differences here.

Why is this study of societal importance?

This study is of social importance because the measures must strike a balance between creating a protective environment and respecting residents' autonomy and dignity. An overview of the measures known in the literature and the associated ethical considerations will help care homes to shape their ideas and strategies in this area. It is recommended that the individual wishes and different backgrounds of residents are taken into account when choosing measures in order to preserve the dignity and human rights of residents with dementia.


Would you like to know more?

You can find this study here:

Sturge, J., Janus, S., Zuidema, S., Frederiks, B., Schweda, M., & Landeweer, E. (2023). The moral and gender implications of measures used to modulate the mobility of people with dementia living in residential care environments: a scoping review. The Gerontologist, gnad071.

Former researcher: Dr. Jodi Sturge

(Changed: 19 Jan 2024)  | 
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