Avoid "psychosocial restraint": Discrepancy of perception between people with dementia and the significant others in the residential care homes of Hong Kong

Abstract

AbstractBackgroundHong Kong is one of the high institutional rates of senior citizens among the developed cities. Residential care homes act as a 'mini‐society' which human interactions happen in these closed settings. The interactions significantly affect the quality of life and self‐perception of people with dementia. Over 50‐80% of the residents lived with different levels of neurocognitive disorder but most of them experienced physical or chemical restraint in the local studies. Worse still, another restraint started developing with the psychosocial restriction and limitation from the significant others in the residential care homes. What should we be alerted?MethodInterpretivism was adopted as a framework in applying participatory observations, in‐depth interviews and other qualitative methods. Ten people with dementia living in a residential care home were interviewed, as were ten members of the care staff. Sixteen visits with approximately 1.5 to 2.0 hours were conducted and field notes of each observation were written for analysis. Two reflective training sessions were provided afterwards.ResultDiscrepancies in perceptions and interpretations of being 'demented' leading to the 'psychosocial restraint' of people with dementia is identified. Living in residential care homes are described as 'triple jeopardy' as being 'old', 'sick' and diagnosed with 'dementia'. With the lack of understanding of the self‐perception of people with dementia and negative stereotyping, the care staff did not talk to the residents with dementia and limited their participation of activities. The residents without dementia also scapegoated and condemned people with dementia in daily interactions. People with dementia perceived themselves as 'being wronged' and argued with the surrounding others. Many complain from other residents happened, which caused the care staff to treat people with dementia as the ‘troublemakers’. As a result, the vicious cycle was found and diminished the quality of life among people with dementia in residential care homes.ConclusionReflective training including (1) Dementia experience from inside out; (2) Subjective voice of people with dementia and person‐centred care; (3) DemenTitudeTM ‐ A proper caring attitude approach and (4) Dementia‐friendly language and interactions is promoted to prevent the rise of 'psychosocial restraint' in the Hong Kong's residential care homes.