Report of the Council on Scientific Affairs. Use of restraints for patients in nursing homes. Council on Scientific Affairs, American Medical Association

Abstract

Objective: To examine issues related to the use of restraints on nursing home patients, including regulations and guidelines, risks and benefits of restraint use, system problems, and measures to reduce restraint use, to determine when the use of restraints results in clinically desirable outcomes.

Methods: Sources of information included a review of published articles and reports, a survey of federal and state regulations and guidelines relating to restraint use in nursing homes, review of current legislative initiatives, and consultation with experts in the field.

Results: The data reveal that restraint use imposes more risk of falls and other undesirable outcomes than it prevents. In response to legislative initiatives and regulatory activities and by implementing alternatives, the prevalence of restraint use has decreased by 20% in recent years. In many states, facilities have created restraint-free environments or restraint-free policies and goals. The Council on Scientific Affairs finds that current federal and state regulations on the use of restraints have benefited the vast majority of nursing home patients.

Conclusions: While guidelines are in place for the use of restraints when clinically necessary, the Council on Scientific Affairs recommends increased research to determine when the use of restraints results in desirable outcomes. Extraregulatory initiatives, such as widespread educational programs, are needed for professionals and consumers to improve awareness of the risks and benefits of restraints, as well as the rights of residents with respect to restraint use.