Interdisciplinary Perspectives on Restraint Use in Aged Care

Abstract

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint; 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.

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

“…The following reasons were given for restraining the patients: age, care dependency, level of disablement, impaired activities of daily living, cognitive status, dementia, Alzheimer's, Parkinson's, negative mood, hallucinations, delusions, disorientation/confusion, depression, preventing dislodgement of feeding tubes, safe use of medical devices, workload, staff culture, location and availability of human resources, negative experiences of nurses, concerns and uncertainties of relatives and legal guardians, and organizational problems such as staff fluctuations and shortages of physicians. The largest number of studies (13) reported the prevention and/or risk of falls to be the main reason for using physical restraints, followed by behavioral problems such as wandering (7), verbal or physical agitation (6), being verbally or physically abusive (1), injury to others (1), shouting, restlessness, aggressiveness, disrobing in public, and resisting care (1), functional impairment (1), urinary or fecal incontinence (3), hip fracture/fall-related fractures (2), history of falls (1), bedfast (1), and being untidy (1). The risk of self-injury was reported in three studies (Finland, Israel, and Singapore) as being the reason for using restraints.…”

Incidence and type of restrictive practice use in nursing homes in Ireland

“…RP are typically broken down into categories such as physical, chemical, mechanical, environmental, seclusion, psychosocial or psychological [ 8 , 9 ]. Research on RP use is complicated by the lack of a common definition for the individual categories of RP and their measurement [ 10 – 12 ].…”

Caregiver‐reported use of physical restraints among community‐dwelling older adults with severe dementia in Singapore

“…Among older adults, physical restraint use is associated with negative psychological and physical effects, such as depression, anxiety, delirium, post‐traumatic stress, loss of strength, bone and muscle mass, incontinence, pneumonia 2,3 and increased functional and cognitive decline 4 . Restraint use has been widely studied in nursing homes where many countries prohibit use, 2,4,5 however, less is understood about restraint use at home 6,7 …”

“…4 Restraint use has been widely studied in nursing homes where many countries prohibit use, 2,4,5 however, less is understood about restraint use at home. 6,7 A recent systematic review found only four studies (all conducted in Europe) estimating a prevalence of restraint use in home care of older adults generally, ranging between five and 25%, 8 with varying understandings of what constituted restraint. 9 Another study in Japan found that 40.5% of home care providers had observed physical restraints.…”