Adecuación de las restricciones físicas y farmacológicas en los ancianos institucionalizados: estudio comparativo en Québec y la Suiza Romanda, con implicaciones en nuestro medio

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Objective a) to examine intra- and inter-country variability in the use of physical restraints and psychotropic medication in institutionalised people older than 65 in Quebec and in Romande, Switzerland, and b) to study the applicability of the results to future studies in Spain. Material and method data were collected through PLAISIR, an information system on persons institutionalised in Quebec and French-speaking Switzerland used for financing and planning, resource allocation and management, utilisation control and quality assurance. Data were obtained from all new admissions to 179 institutions in Quebec (n =8183) and to 250 institutions in Switzerland (n =7592) in 1998. Physical restraints were classified into fixed and mobile. Daily and weekly uses of psychotropic medication were coded by defined daily doses. The prevalence of the use of physical restraints and psychotropic medication were estimated and an index of the appropriateness of the use of each was calculated by an indirect adjustment method. A logistic regression model on the use of both types of restriction based on residents’ health and functional status was calculated to estimate expected values of use. Results the rate of dependency was high in residents of both regions. Approximately 80% of residents in French Switzerland and 90% of those in Quebec were dependent for activities of daily living. Intra- and inter-country variability in the use of restrictions is high: psychotropic medication was more often used in French Switzerland (78%) than in Quebec (67%), while physical restraints were more often used in Quebec (76%) than in French Switzerland (40%). The appropriateness of use varied widely within both regions and cannot be fully explained by the characteristics of the residents. Conclusions the high variability in the use of physical restraints and psychotropic medication may be a result of the absence of standards of quality and/or legislation both in Quebec and in French Switzerland. This research illustrates a method that could be useful to investigate the prevalence and appropriateness of the use of these restriction methods in Spain.