Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan

Abstract

Background: The use of physical restraints by family caregivers with home-dwelling elders has not been extensively studied but it might be widespread. Furthermore, it is also not clear how home care providers who support family caregivers perceive the use of physical restraint in elders' homes. This study assessed family caregivers' and home care providers' knowledge and perceptions of physical restraint used with elders living at home in Japan, a country with the highest proportion of elders in the world and where family caregiving is common. Methods: We undertook a cross-sectional study of 494 family caregivers, 201 home helpers, 78 visiting nurses, 131 visiting physicians, and 158 care managers of home-dwelling frail elders needing some care and medical support in Japan, using questionnaires on knowledge of 11 physical restraint procedures prohibited in institutions and 10 harmful effects of physical restraints, perceptions of 17 reasons for requiring physical restraints, and experiences involving physical restraint use. Results: Family caregivers were aware of significantly fewer recognized prohibited physical restraint procedures and recognized harmful effects of physical restraint than home care providers, and differences among home care providers were significant. The average importance rating from 1 (least) to 5 (most) of the 17 reasons for requiring physical restraints was significantly higher among family caregivers than home care providers, and significantly different among the home care providers. Moreover, these differences depended in part on participation in physical restraint education classes. While 20.1% of family caregivers had wavered over using physical restraints, 40.5% of home care providers had seen physical restraints used in elders' homes and 16.7% had advised physical restraint use or used physical restraints themselves.

Behind Closed Doors: Involuntary Treatment in Care of Persons with Cognitive Impairment at Home in the Netherlands

“…Family plays an important role in choosing to use involuntary treatment in caring for persons with cognitive impairment, which is consistent with recent studies on physical restraints . Family caregivers, faced with complex care situations and in distress, reach for quick solutions such as involuntary treatment.…”

“…Family plays an important role in choosing to use involuntary treatment in caring for persons with cognitive impairment, which is consistent with recent studies on physical restraints. 4,5 Family caregivers, faced with complex care situations and in distress, reach for quick solutions such as involuntary treatment. To illustrate, caregivers who want to minimize the risk of harm or injury may perceive physical restraints as the only way to prevent falls or injuries or to control behavioral symptoms in persons with cognitive impairment, 20,21 but family and professional caregivers do not always realize that restraints have negative effects on persons with cognitive impairment and, for example, may increase the risk of falling with injury.…”

“…Although information on restraint use in older persons receiving home care is scarce, there are strong indications that physical restraints are used in home care [3][4][5] and that family caregivers request restraint use. 4,5 The first prevalence figures concerning the use of physical restraints in home care recently reported in eight European countries 6 show an overall use of physical restraints in 10% of 1,223 persons with dementia, ranging from 3% in the Netherlands and 4% in England to 18% in Spain and 20% in Germany. Furthermore, the overall use of psychotropic medication was 56%, ranging from 38% in the Netherlands and 42% in Estonia to 74% in Spain and 76% in France.…”

Validity and measurement invariance of the Physical Restraint Use Questionnaire (PRUQ) in nursing staff

“…Nevertheless, this training does not appear to have influenced their perception of the use of physical restraint. In this sense, it seems that Spanish professionals still consider it an important procedure, especially if the data obtained in this study are compared with those collected in other countries (Kong, Song, & Evans, ; Kurata & Ojima, ).…”

Professional and family caregivers’ attitudes towards involuntary treatment in community‐dwelling people with dementia

“…Almost 42% of family caregivers believed that the use of physical restraints is unavoidable, and the majority of family caregivers consider physical restraints as appropriate and is willing to use them with a relative (Estévez-Guerra et al, 2017). Family caregivers are often not aware of regulations to prohibit or minimize involuntary treatment and the harmful physical and psychological effects (Kurata & Ojima, 2014;Estévez-Guerra et al, 2017).…”