Physical restraints among the elderly in the acute care setting: Prevalence, complications and its association with patients’ characteristics

Abstract

Aims: This study aimed to identify the prevalence and circumstances of the use of physical restraints, complications associated with its use and its association with patients’ characteristics. Methods: This is a prospective observational study design. A convenience sample of elderly patients (aged 65 and above) who were admitted to an acute care hospital from February 2012 to August 2012 were tracked daily to monitor the use of physical restraints during hospitalization. Patient-related variables and type of physical restraint used were gathered from the medical records and the Multi-Dimensional Dementia Assessment Scale was completed through interviews with nurses who had cared for the patients. Independent t-test or Chi-square (χ2) tests were used to examine the effect of a single variable on the use of physical restraints. Multiple logistic regression was done to predict the patient-related variables to the likelihood of being placed on physical restraints. Results: Altogether, 998 patients accounting for 1048 admission episodes, were included in this study, of which 84 admission episodes involved the use of physical restraints (8%). Major reasons for restraints include ‘Behavioural/confused/violent’ ( n= 55; 65%) and to prevent falls ( n=53; 62%). Regression analysis indicated that male gender, behavioural changes, memory disturbance, impaired physical function, the use of anti-psychotic drugs and higher psychiatric workload predicted the likelihood of being put on physical restraints. The strongest predictor was memory disturbances with an odds ratio of 30. Conclusion: The prevalence of physical restraints used was higher than that in published literature for acute care hospitals. Preventive strategies would need to be targeted for the elderly, who suffered from memory disturbances upon admission.