Elderly/Long-Term Care

Use of physical restraints in nursing homes creates substantial adverse consequences for residents

The use of restraints on nursing home residents has declined markedly from 44 percent of residents in 1989 to about 9 percent currently. Yet in those remaining cases, restraints substantially impair residents' health, reveals a new study. It found that 3 months after being restrained, residents had lower cognitive performance, lower ability to perform activities of daily living (ADLs) like dressing and bathing, and more walking dependence. Specifically, when a resident was restrained, one could expect 5 percent lower ADL performance, 10 percent more walking dependence, and 4 percent lower cognitive performance compared with no restraint use.

Nicholas G. Castle, Ph.D., of the University of Pittsburgh, and colleagues compared the outcomes of newly admitted residents of 740 Pennsylvania nursing homes who were not restrained in the first 2 quarters of their residency. They examined which facility and individual characteristics during the first two quarters were linked with restraint initiation during the third quarter. Finally, they examined third-quarter restraint use with fourth-quarter health status.

The initiation of restraint use was associated with a previous fall, psychoactive medication use, low cognition, ADL scores, and the absence of pressure ulcers, as well as a variety of facility characteristics. In addition to creating adverse health consequences for residents, use of restraints may necessitate subsequent use of additional staff as a result of resident decline. It may then be more expensive to restrain residents than not restraining them in the first place. These findings also provide further justification for policymakers to implement restraint reduction policies and provide resources to promote restraint reduction. The study was supported in part by the Agency for Healthcare Research and Quality (HS13983).

See "Physical restraint initiation in nursing homes and subsequent resident health," by John Engberg, Ph.D., Dr. Castle, and Daniel McCaffrey, Ph.D., in the August 2008 Gerontologist 48(4), pp. 442-452.

Return to Contents
Proceed to Next Article