Physical and chemical restraints in acute care: Their potential impact on the rehabilitation of older people

Abstract

Agitation is a major problem for older people and is present in over half of the hospitalizations for people > 65 years of age. In a previous study by the authors, results indicated that nursing actions often did not meet best-practice standards in the care of older, agitated patients. This paper builds on these results by reviewing the literature pertaining to the use of restraints and contributes to the body of knowledge surrounding the impact of the acute-care experience on rehabilitation outcomes. Successful rehabilitation relies on the improvement of functional health outcomes and, for this to happen, physical and emotional well-being are important. The sequelae of restraint use in acute care have the potential to alter peoples' ability to participate fully in a rehabilitation programme, thereby placing their future placement at risk. This paper explores the outcomes of restraint use in the acute-care setting and presents the argument that their effects are likely to be detrimental to rehabilitation outcomes.

Inactivity and Inflammation in the Critically Ill Patient

“…These changes may contribute to delirium and exacerbation of dementia in the ICU. Hospitalized patients who are confused and agitated are more likely to be sedated and restrained, contributing to immobility and subsequent complications [34].…”

Effect of Physical Restraint Reduction on Older Patients’ Hospital Length of Stay

“…Physical restraints have been shown to lead to delirium, agitated behaviors, nightmares, and feelings of powerlessness. 12,32 These negative psychological effects outcomes may interfere with treatment progress, 33 and therefore prolong LOS. Unfortunately, we did not have longitudinal data on cognitive function, delirium, or mood to support the notion that restraint reduction can prevent or shorten the duration of delirium that is associated with poor clinical outcomes.…”

Use of Physical Restraints in a Rehabilitation Setting: Findings from a Point Prevalence Survey

“…This should be a mutual goal, and health professionals need to emphasize the patient's role and provide opportunities for full participation in order for the patient to actualize his/her potential [42]. Restraint use restricts the active participation of patients, which is a crucial component in optimizing recovery [43].…”