Physical restraint use and falls in nursing home residents
E. Capezuti
Bok Engelsk 1996
| Utgitt | 1996
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| Omfang | Side 627- 633
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| Opplysninger | OBJECTIVE: To examine the relationship between restraint use andfalls while controlling for the effect of psychoactive drug use amongnursing home residents, including subgroups of nursing home residentswith high rates of restraint use and/or falls.DESIGN: Secondary analysis of data from a longitudinal clinical trialdesigned to reduce restraint use.SETTING: Three nursing homes.PARTICIPANTS: Subjects (n = 322) were either restrained (n = 119) ornever restrained (n = 203) at each observation point during a 9.5-month data collection period that preceded the intervention phase ofthe clinical trial.MEASUREMENTS: We evaluated restraint status (independent variable)three times during the data collection period by direct observationover a 72-hour period. Incident reports documenting falls and fall-related injuries (dependent variables) were reviewed. Cognitivestatus was measured using the Folstein Mini-Mental State Exam andfunctional status (including ambulation status) by thePsychogeriatric Dependency Rating Scale. Psychoactive drug useprofile was obtained through record review.MAIN RESULTS: Using multiple logistic regression, we compared theeffect of restraint use on fall risk between a confused ambulatorysubgroup and the remaining sample and found a significant differencein the odds ratio for falls and recurrent falls (P = .02; chi-square= 5.24, df = 1; P = .003, chi-square = 9.12, df = 1). In the confusedambulatory subgroup, restraint use was associated with increasedfalls (odds ratio: 1.65, 95% CI: 0.69, 3.98) as well as recurrentfall risk (odds ratio: 2.46, 95% CI: 1.03, 5.88). Increased falls andrecurrent fall risk was not observed in the remaining sample (fallsodds ratio: 0.49, 95% CI: 0.28,0.87; recurrent falls odds ratio:0.42, 95% CI: 0.20,0.91). One subgroup, the nonconfused ambulatoryresidents, were never restrained; after removing this subgroup, theconfused ambulatory continued to be associated, though notsignificantly, with a higher risk of falls and injuries. Onlynonconfused nonambulatory restraints were associated with a lowerrisk of all three outcomes: falls (odds ratio: 0.28, 95% CI: 0.05,1.58), recurrent falls (odds ratio: 0.48, 95% CI: 0.05, 4.72), andinjurious falls (odds ratio: 0.42, 95% CI: 0.04, 4.01); theseresults, however, were not statistically significant. There was noevidence that the effect of restraint use on fall risk depended uponthe use of psychoactive drugs (chi square = 4.43; df = 2, P = .11).CONCLUSION: Restraints were not associated with a significantly lowerrisk of falls or injuries in subgroups of residents likely to berestrained. These findings support individualized assessment of fallrisk rather than routine use of physical restraints for fallprevention. Researchers and clinicians should continue to focusefforts on developing a variety of approaches that reduce risk offalls and injuries and promote mobility rather than immobility.
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