On the persistence of coercive practices in dementia treatment. When plans, spaces, and discourses matter

Over the last three decades, the enactment of coercive practices to contain the so-called «challenging behaviors» associated with dementia (e.g., wandering, biting, agitation, and physical attacks) has been widely delegitimized by public opinion and the scientific community in favor of practices and principles promoted by the so-called culture change movement. Nevertheless, mechanical and anesthesiological restraints continue to persist widely in nursing homes dedicated to people with dementia. This paper explores the reasons behind this persistence, drawing upon a two-year ethnography in two nursing homes in Northeast Italy. Adopting a practice-based approach, grounded mainly on studies that have used the practice concept to understand organizational dynamics, this paper explores the role of plans of action, physical spaces, and discourses in supporting the reiteration of coercive practices. In doing so, the work also pays attention to the struggles encountered by workers in enacting the practices born in opposition to the use of coercion (e.g., non-pharmacological therapies and the adaptation of physical spaces to the needs of people that live with dementia) and that should replace body restraints and sedation in the management of disruptive behaviors