Effectiveness of bedrails in preventing falls among hospitalized older adults: a systematic review

Abstract

EXECUTIVE SUMMARY Background Falls are a major problem today affecting adults of any age, but the elderly are a population that is more susceptible to falls. Falls are the leading cause of injury or death among older adults. Hospitalized older people are particularly vulnerable to falls. Falls cause direct injuries (minor injuries, severe wounds of the soft tissues and bone fractures) to patients and increased length of stay. The prevention of falls is commonly considered an indicator of the quality of care. Therefore, health institutions and professionals treat the identification and implementation of strategies to prevent or minimize their effects as a high priority. Fall prevention interventions involving physical restraints are still common and considered a primary preventative measure, despite controversy in their use. One of the most frequently used restraint interventions is bedrails. The question of the effectiveness of bedrails in preventing falls cuts across all societies and cultures and has with significant implications for the clinical practice of nurses. Objectives The objective of this review was to identify the effectiveness of the use of bedrails in preventing falls among hospitalized older adults when compared with no use of bedrails or any type of physical restraints. Inclusion criteria Types of participants The current review considered studies that included hospitalized adults (female and male), 65 years and over with any clinical condition in a non-intensive care unit (ICU). Types of intervention(s) The current review considered studies that evaluated the use of bedrails as a restraint to prevent falls among older adults in non-ICUs compared to no use of bedrails or any type of physical restraints, for example, bedrails versus no bedrails, and bedrails versus no wrist or ankle ties. Types of studies The current review considered any randomized controlled trials (RCTs). In the absence of RCTs, other research designs such as non-RCTs, before and after studies, cohort studies, case-control studies, descriptive studies, case series/reports and expert-opinion were considered. Outcomes The current review considered studies that included primary outcomes (number of patients who fell or the number of falls per patient) and secondary outcomes (number of head trauma, bone fractures or soft tissue injuries). Search strategy The search strategy aimed to find both published and unpublished articles. A three-step search strategy was utilized in 13 databases. Articles published in Portuguese, English and Spanish beginning from 1980 were considered for inclusion. Methodological quality Assessment of methodological quality was not conducted as no articles were identified that met the inclusion criteria. Data extraction and data synthesis Data extraction and synthesis was not performed, because no articles were included in this systematic review. Results The search identified a total of 875 potentially relevant articles. Sixteen articles were identified through the reference lists of all identified articles. One hundred and thirteen full-text papers were assessed by two independent reviewers to determine eligibility. However, 11 articles were not found (despite all the efforts), and 102 articles did not meet the inclusion criteria. Conclusion There is no scientific evidence comparing the use of bedrails in preventing falls among hospitalized older adults to no use of bedrails or any type of physical restraints.

Physical Restraint Use in Nursing Homes—Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies

“…Bed rails were more common in the Netherlands [29,35,52] and Spain [48] than in Germany [47] and Switzerland [41]. These findings are consistent with previous studies focusing on physical restraint use in nursing homes [20,28,45,66,71]. Although bed rails may seem harmless, and even help one to sleep better by eliminating the fear of falling out of bed, injuries can still occur, such as getting caught between the rails [19,72].…”

“…Sadly, this scoping review revealed the continuing popularity of physical restraint. According to Marques and colleagues, the prevention of falls is often considered an indicator of quality of care [71]. Therefore, physical restraint may be used to decrease falls and thus make the nursing home staff look good.…”

Effectiveness of nursing care provided for fall prevention: Survival analysis of nursing records in a tertiary hospital

“…On high fall‐risk days, our finding of infrequent restraint assessment by nurses was found to be associated with increased fall‐risk. Although many healthcare professionals regard physical restraint as an option to prevent at‐risk patients from falling (Aranda‐Gallardo et al, 2018), there is some controversy regarding the association between restraint use and falls (Marques, Queiros, Apostolo, & Cardoso, 2017; Sze, Leng, & Lin, 2012). Based on our result that restraint assessment was not related to fall occurrence in the data from the total cohort days, it would appear that restraints are not causally related to fall occurrence in general.…”

Promoting evidence-based practice: training health professionals for the evidence synthesis

“…Therefore, due to the training and guidance of several health professionals, researchers, and professors in the areas of nursing, medicine, and psychology, 13 systematic reviews have been published in the JBI Evidence Synthesis, being seven systematic reviews of effectiveness (18)(19)(20)(21)(22)(23)(24) , two reviews of reviews (25,26) , one systematic review of qualitative evidence (27) , one systematic review of prevalence and incidence (28) , and two scoping reviews (29,30) . Globally, these reviews address different themes of relevance to the field of nursing, as follows: active aging, differentiated nursing care methodologies (complex), wound care, transitions in health and self-care, and health education and literacy.…”