Physical and Pharmacologic Restraint of Nursing Home Patients With Dementia

Abstract

This case-control study of 31 specialized dementia units and 32 traditional units in five states investigated use of physical and pharmacologic restraints among 625 patients with the diagnosis of dementia. Physical restraints were observed in use on 18.1% of dementia unit patients and on 51.6% of comparison unit patients who were out of bed during the day (adjusted odds ratio, 0.283;95% confidence interval, 0.129 to 0.619). Pharmacologic restraints were routinely given to 45.3% of dementia unit patients and 43.4% of comparison unit patients (adjusted odds ratio, 0.950; 95% confidence interval, 0.611 to 1.477). We used multivariate logistic regression to identify residence in a nonspecialized nursing home unit, nonambulatory status, transfer dependency, mental status impairment, hip fracture history, and a high nursing staff-to-patient ratio, which we found to be independent predictors of physical restraint use. Physically abusive behavior, severe mental status impairment, and frequent family visitation were found to be significant predictors of pharmacologic restraint use, while advanced patient age, large nursing home size, and patient nonambulatory status were protective against such use. These results support the conclusion that physical and pharmacologic restraint constitute separate treatment modalities with different risk factors for use, and indicate that specialized dementia units are successful in reducing the use of physical but not pharmacologic restraints.

Reducing the use of physical restraints in nursing homes: will it increase costs?

“…Previous research, however, indicates that those major determinants of being restrained that are correlated with resource use (i.e., cognitive status, behavioral problems, performance of activities of daily living) are included in our singlestage ordinary least squares model. 47 All the independent variables in these ordinary least squares models are binary. The statistical significance of model parameters is reported because these data are subject to various sources of random error (e.g., measurement process error).…”

Use of physical restraints and psychotropic medications in Alzheimer special care units in nursing homes

“…Previous research has consistently found lower use of restraints in SCUs, but results have been mixed on the use of psychotropic medication in SCUs. 10,11 Our results imply that the industry as a whole may have caught up with SCUs in physical restraint policy. The most plausible reason that we once saw, but no longer see, any difference in the use of restraints in SCUs and non-SCUs is that, owing to OBRA-87, the non-SCUs have reduced the use of restraints to the lower levels seen earlier in SCUs.…”

“…One study found residence in an SCU to be associated with a lower likelihood of physical restraint and no difference in the likelihood of pharmacologic restraints. 10 Another study found lower levels of restraint use in SCUs but higher levels of antipsychotic drug use. 11 However, both studies were carried out before full implementation of the Omnibus Reconciliation Act of 1987 (OBRA-87) requirements that emphasized reduced use of physical restraints and antipsychotic medication in nursing homes.…”

“…Also, unlike the units included in previous studies, the units used in this study were not chosen because of their reputed high quality of care, nor were they part of the initial wave of SCU development that may have more heavily represented higher-quality facilities. 10,11 Finally, these data were gathered more than 2 years after the implementation of the OBRA-87 reforms, so the use of restraints and medication in all study facilities should reflect the post-OBRA, industrywide changes in care strategies. …”

“…4,11 On the basis of previous research, we included a number of covariates in the models. [5][6][7]10,11,26,27 These included a resident's age, sex, source of payment, length of stay, performance of activities of daily living (ADL), cognitive performance, history of falls, body control problems, and behavior problems. Other covariates reflected a facility's ownership, location (i.e., state), and size.…”