Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan

Abstract

Introduction The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. Methods In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. Results In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. Conclusion Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.

Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis

“…The increased chemical restraint use within Ontario hospitals that we observed is similar to reported increases in nursing homes [ 13 ]. Our finding of increased physical restraint use is novel within a Canadian context, though similar results were reported in patients with dementia admitted to acute care hospitals in Japan during the COVID-19 pandemic [ 30 ]. While we cannot conclusively determine the reasons behind this increased restraint use, one likely contributor was restrictive hospital visitation policies that increased social isolation and reduced opportunities for caregiver advocacy [ 31 ].…”

“…dementia admitted to acute care hospitals in Japan during the COVID-19 pandemic [30]. While we cannot conclusively determine the reasons behind this increased restraint use, one likely contributor was restrictive hospital visitation policies that increased social isolation and reduced opportunities for caregiver advocacy [31].…”

Staff perceptions of the consequences of COVID‐19 on quality of dementia care for residents in Ontario long‐term care homes

“…Specific concerns include that the isolation of residents and the loss of support and advocacy from families may have resulted in a worsening of markers of quality in LTC, such as increases in the use of physical restraints or psychotropic medications such as antipsychotics, 10 , 11 which have both been widely reported among persons with dementia in other settings. 12 , 13 , 14 …”

“…Specific concerns include that the isolation of residents and the loss of support and advocacy from families may have resulted in a worsening of markers of quality in LTC, such as increases in the use of physical restraints or psychotropic medications such as antipsychotics, 10,11 which have both been widely reported among persons with dementia in other settings. [12][13][14] To address the dearth of empirical data in this area, we conducted a survey among staff who worked in LTC homes in Ontario, Canada during the initial waves of the pandemic. This reflects a period when Ontario LTC homes implemented strict measures including masking, visitor and activity restrictions, and resident isolation and testing protocols to limit the introduction and spread of the virus.…”

Characteristics of COVID‐19 delirium intervened by a psychiatric liaison team in the first 2 years of the COVID‐19 pandemic in Japan

“…Physical restraints are usually used to prevent medical accidents, such as falls and stumbles, and to protect patient safety. Physical restraints may also have to be used in cases of COVID‐19 delirium to prevent the spread of infection, which has been reported to increase in hospitals that have COVID‐19 patients, 6 but they exacerbate delirium.…”