Thailand Issues Dementia Care Guidelines: No Restraints, No Confinement, No Abuse

Thailand's Department of Medical Services has issued recommendations for caring for older adults with dementia, emphasizing compassionate, safe and dignified treatment while advising families and caregivers how to respond to behavioral changes without violence, unnecessary restraints or confinement.

Thailand's Department of Medical Services (DMS), Ministry of Public Health, has outlined recommendations for the care of older adults living with dementia, following public concerns about the treatment of elderly patients experiencing dementia-related behavioral and psychiatric symptoms.

Dr. Weerawut Imsamran, Director-General of the Department of Medical Services, said the department convened a meeting on October 15, 2026, with medical institutions and professional organizations to develop practical recommendations for healthcare professionals, families and the general public.

The meeting involved the Somdet Phra Sangharaja Yannasangvara Institute of Geriatric Medicine, the Neurological Institute of Thailand, the Dementia Association of Thailand and the Thai Geriatric Psychiatry and Neuropsychiatry Club.

The recommendations emphasize four principles: no physical restraint, no tying patients down, no confinement and no abuse.

Dementia Symptoms Go Beyond Memory Loss

According to the Department of Medical Services, dementia is not limited to forgetfulness or memory impairment.

Older adults with dementia may also experience behavioral and psychological symptoms that affect their emotions, communication and daily activities.

Common changes may include:

• Apathy: Loss of interest in activities or hobbies previously enjoyed.

• Emotional changes: Increased sadness, frequent crying, irritability or mood fluctuations.

• Agitation: Restlessness, difficulty remaining calm or problems controlling actions.

• Changes in behavior: Uncharacteristic speech, actions or socially inappropriate behavior.

• Hallucinations or delusions: Seeing, hearing or believing things that do not correspond to reality.

Recognizing these symptoms can help families and caregivers respond with understanding rather than interpreting the behavior as intentional misconduct.

Sudden or significant changes should also prompt medical evaluation, as physical illness or other treatable conditions may contribute to behavioral disturbances.

How Caregivers Should Respond to Aggressive Behavior

Dr. Busakorn Loharachoon, Director of the Somdet Phra Sangharaja Yannasangvara Institute of Geriatric Medicine, emphasized that understanding, patience and attentive care are essential when supporting older adults with dementia.

When a patient becomes agitated, aggressive or distressed, caregivers are advised to follow four practical steps:

1. Stay Calm

Caregivers should remain composed and avoid reacting with anger or confrontation.

2. Stop the Current Activity

If an activity appears to trigger distress or agitation, pause it rather than forcing the patient to continue.

3. Maintain a Safe Distance

Allow the person sufficient space to calm down while maintaining a safe environment.

4. Seek Assistance

If the situation becomes difficult to manage, seek help from qualified healthcare professionals or other appropriate support personnel.

The department advises caregivers not to use physical force, struggle with patients or respond aggressively.

Patients experiencing concerning behavioral changes should be assessed by a physician to identify possible underlying physical causes and determine appropriate treatment.

Four Essential Principles: No Restraints, No Confinement, No Abuse

The Department of Medical Services stresses that dementia care should prioritize safety, compassion and respect for human dignity.

Its central message is:

“No physical restraint. No tying down. No confinement. No abuse.”

Families and caregivers are encouraged to avoid physical violence, verbal aggression, intimidation and coercion.

Sedative or sleeping medications should not be used simply to control behavior without appropriate medical assessment and a physician's direction.

Instead, the department recommends supportive approaches, including creating a safe living environment, preventing wandering without locking patients away, and communicating calmly and respectfully.

Caregivers should use short, clear sentences, speak in a gentle tone and listen attentively to the patient's feelings and concerns.

Prescribed medications should be administered strictly according to medical instructions.

These approaches aim to reduce distress while preserving the patient's comfort, autonomy and dignity.

Five Key Factors When Choosing a Dementia Care Facility

For families considering residential care because an older adult can no longer safely remain in their previous living environment, the department recommends visiting facilities in person and checking their operating licenses.

Families should also provide complete information about the patient's medical conditions, behavioral symptoms and care needs.

The department identifies five important areas to assess before selecting a care facility.

1. Safe and Accessible Environment

Facilities should be clean, well-lit and designed to reduce risks for older adults.

Important features include appropriate handrails, mobility assistance equipment and other accessibility measures.

2. Adequate and Trained Caregivers

Facilities should employ appropriately trained personnel and maintain sufficient staffing to provide care during both daytime and nighttime hours.

3. Health-Promoting Activities

Appropriate activities should be available to support physical, cognitive and emotional well-being.

Such activities may help maintain functioning and support quality of life among residents with dementia.

4. Emergency Response and Family Communication

Care facilities should have established procedures for responding to medical emergencies.

Families should also be able to communicate with staff and receive updates about the patient's health, safety and daily well-being.

5. Appropriate Food and Nutrition

Facilities should provide clean drinking water and nutritious meals suited to each resident's health conditions.

Special attention should be given to patients with swallowing difficulties or dietary requirements associated with chronic diseases.

Supporting Families and Professional Caregivers

Dementia care can be challenging for families, particularly when patients experience agitation, confusion, changes in personality or difficulty communicating their needs.

The department's recommendations aim to improve understanding of these challenges and encourage appropriate responses from both informal caregivers and professional care providers.

The guidance also highlights the importance of cooperation among healthcare institutions, families and residential care facilities.

Early recognition of behavioral changes, timely medical assessment and appropriate environmental adjustments can support safer and more compassionate care.

Thailand Promotes Dignity and Safety in Elderly Care

Thailand's latest dementia care recommendations reinforce the importance of protecting older adults from neglect, unnecessary restrictions and mistreatment.

The guidance is relevant to families caring for older relatives at home as well as healthcare organizations and residential elderly care providers.

For families evaluating long-term care services in Thailand, the department's recommendations provide practical considerations for assessing safety, staffing, communication and individualized support.

The Department of Medical Services emphasizes that effective dementia care begins with understanding and compassion, supported by a safe environment, appropriate medical care and respect for every older person's dignity.

 

Source: Thailand Department of Medical Services, Ministry of Public Health. Recommendations developed following the multidisciplinary meeting held on October 15, 2026.