Characteristics of the nursing home as well as the physical and mental condition of the resident have an impact on whether physical restraints are used, according to a recent study.
The study showed that mental illness combined with severe inability to perform activities of daily living (ADL) was significantly associated with use of restraints. The study, however, also showed that restraint use was low when mental illness was not coupled with ADL impairment.
The study used data from 441 newly admitted nursing home residents. Burton and colleagues divided the eight nursing homes in the study into "high-use" and "low-use" homes. In high-use homes, the proportion of residents with any restraint use during the year was 73%, compared with 55% in lowuse homes. "These variations suggest that staff attitudes toward how much to protect from falling and how much to assist in ADLs may be the underlying factor to the differences in restraint use," according to the researchers.
The largest and most sustained difference was that high-use homes restrained persons who needed help walking whereas staff in low-use homes did so less often. The study found that restraints were used if patients were unable to dress, toilet, transfer from bed to chair, feed themselves, and if they needed help walking. The researchers noted that if the resident had neither mental illness nor severe ADL impairment, the use of restraint was low, but having both conditions was a strong predictor for high use. Interestingly, having either condition without the other was associated with low use.
For more information, contact Linda Harootyan, The Gerontological Society of America, 1275 K Street, NW, Suite 350, Washington, DC 200054006; 202-842-1275.