Theorising Dementia as a Risk Classification: Sociotechnical Imaginaries of Safety and Order in Acute Hospital Care of People Living with Dementia

People living with dementia are one of the populations most at risk of restrictive intervention during an acute hospital admission. These restrictive interventions are typically justified by staff concerns about patient safety and as a means of mitigating against falls, itself a key metric of quality care in acute settings. Drawing on Jasanoff and Kim’s concept of sociotechnical imaginaries, this paper explores how healthcare professionals imagine risk and safety, and how these imaginaries contour the use of restrictive practice. Data collection comprised 225 days of ethnographic observation and 1168 in situ interviews with patients, families, and ward staff at (n = 6) NHS Trusts working in (n = 3) dyads for acute and mental health care across England. Data were analysed thematically using NVivo. Findings were grouped into three major themes: institutional cultures, institutional anxiety, and atrocity stories. The study reveals tensions between ways in which people living with dementia respond to admissions and the institutional imaginaries of a safe, risk-free ward, alongside expectations of “good patienthood.” It argues that these imaginaries produce dementia as a risk classification, where bed or bedside-bound patients who do not demand staff attention inform the routine use of restrictive practices. These interventions, however, often result in distress and feelings of imprisonment among people living with dementia, which in turn prompts further tightening of restraints on this vulnerable population.