Caregiver decision-making concerning involuntary treatment in dementia care at home

Vincent R. A. Moermans*, A.M.H.J. Mengelers, Michel H. C. Bleijlevens, Hilde Verbeek, Bernadette Dierckx de Casterle, Koen Milisen, Elizabeth Capezuti, Jan P. H. Hamers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background:
Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment.

Objective:
To identify and describe family caregivers’ experiences regarding care decisions for situations that can lead to involuntary treatment use in persons living with dementia at home.

Research design:
A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven.

Participants and research context:
A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling.

Ethical consideration:
The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland.

Findings:
Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences.

Discussion and conclusion:
To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations.
Original languageEnglish
Article number09697330211041742
Pages (from-to)330-343
Number of pages14
JournalNursing Ethics
Volume29
Issue number2
Early online date6 Dec 2021
DOIs
Publication statusPublished - Mar 2022

Keywords

  • Involuntary treatment
  • Dementia
  • Home care
  • Family caregiving
  • Qualitative research
  • ethics and dementia care
  • family caregivers
  • PERSON-CENTERED CARE
  • OLDER-ADULTS
  • COGNITIVE IMPAIRMENT
  • PHYSICAL RESTRAINT
  • FAMILY CAREGIVERS
  • home care
  • safety
  • NEEDS
  • PEOPLE
  • Autonomy
  • involuntary treatment

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