Practical consequences and ethical implications of measures impacting the life-space mobility of people with dementia living in nursing home environments: a scoping review

Closed door policies in dementia special care units are being contested where they limit individual freedom and mobility of residents. Questioning the use of such policies relates to the growing interest in involuntary care and the rights of older persons in long-term care and highlights moral questions regarding the balance between freedom and safety (Graham, 2021; Hamers et al., 2016; Schulmann et al., 2018). Understanding the legal position of people in long-term care has highlighted the morality of using interventions, such as physical restraints and restrictive practices, in countries such as Spain, Portugal, and the Netherlands(Estévez-Guerra et al., 2017; Ferrao et al., 2021; Frederiks, 2020; Frederiks et al., 2017; Hofmann et al., 2015; Scheepmans et al., 2018). Additionally, countries such as Canada, England, Finland, Germany, the Netherlands, and Norway continue to explore policy that restricts the right to self-determination in the care of older people, including the ethics of using closed-door policies and surveillance technologies(Dixon et al., 2020; Driessen et al., 2017; Landeweer et al., 2021; Lowndes et al., 2021; Niemeijer et al., 2015; Piirainen et al., 2021; Tufford et al., 2018). Further, it is essential to consider the principles of human rights (respect, freedom, dignity and equality) of people with dementia to live meaningful lives in environments that meet their individual needs (Charras et al., 2016). Unfortunately, this is not a common practice where dementia environments rarely reflect the diversity and equity of the patient population. For instance, dementia (e.g., Alzheimer's disease) disproportionately affects women more than men in both prevalence and severity (Carter et al., 2012).. However, nursing home environments rarely consider sex and gender in the design and operations. Further, there is minimal knowledge on gender-specific measures used to prevent people with dementia from exiting a nursing home environment. Therefore, this scoping review aims to provide an overview of the characteristics, ethics and gender considerations of using measures to prevent people with dementia from leaving a nursing home environment.