Friday, June 2, 2023

Physical Restraints Linked to Poorer Outcomes Among Older Patients With Dementia

Older patients with dementia and behavioral disturbances who are physically restrained during hospitalizations spend more days in the hospital and are less likely to be discharged to their home compared with peers who are not physically restrained during hospitalization, a study in the Journal of the American Geriatrics Society has found.

“Multidisciplinary approaches involving all health care team members, in partnership with families, are needed to minimize the use of [physical restraints] and lessen the negative consequences when they are introduced,” wrote Amteshwar Singh, M.D., M.Ed., of the Johns Hopkins University School of Medicine and colleagues.

The researchers analyzed data from 991,605 older patients coded for dementia with behavioral disturbances in the National Inpatient Sample from 2016 to 2020; of this group, 6.5% were physically restrained while they were hospitalized.

Compared with patients who were not restrained, those who had been physically restrained remained hospitalized roughly 2.6 days longer, were 26% less likely to be discharged to home, and accrued an average of $13,150 more hospital charges. Overall, 5.3% of those who had been restrained died while they were hospitalized compared with 4.0% of those who had not. The study also revealed disparities regarding the patients who were restrained: 8.2% of Black patients were restrained compared with 6.2% of White patients.

“Beyond the physical affront, [physical restraints] bring psychological trauma to patients because of the perception of coercion and an assault on their dignity,” Singh and colleagues wrote.

“Ideally, [physical restraints] would never be employed, but each decision to use restraints is context-dependent and must be individualized to ensure the protection of all,” the researchers added. “[E]mploying physical restraints must always be carefully considered and used only after all other measures have been exhausted, given the associations with worse clinical and resource utilization outcomes.”

For related information, see the Psychiatric Services article “APA Resource Document Outlines Principles on Use of Seclusion, Restraint.”

(Image: iStock/bymuratdeniz)

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