Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors

Abstract

The patterns of and risk factors for mechanical restraint use were determined in 12 skilled nursing facilities. Restraints were being used for 59% of residents at the beginning of the study; 31% of remaining residents were restrained during the follow-up year. No facility characteristic was associated with restraint use. The resident characteristics independently associated with initiation of restraints were older age, disorientation, dependence in dressing, greater participation in social activities, and nonuse of antidepressants. Unsteadiness (72%), disruptive behavior such as agitation (41%), and wandering (20%) were the most frequently cited reasons for initiation of restraints.

KIE: The aims of this 1-year, prospective observational cohort study were to 1) describe the prevalence and incidence of restraint use among elderly residents in 12 New Haven, Connecticut area nursing homes; 2) describe the patterns and duration of restraint use; 3) identify the reasons for initiating restraints; and 4) identify the resident and nursing home characteristics associated with mechanical restraint use. The authors found that the use of mechanical restraints in nursing homes was common and usually intermittent for reasons of safety and behavior in disoriented, active residents. While their results verify the impression that restraint use is perceived as involving a choice between safety and independence, the authors discovered little data concerning the effectiveness of restaints on reducing injury or improving behavior among elderly nursing home patients.