Care of the Confused Elderly Patient

Patrick, Maxine

doi:10.2307/3453583

Cited by 2 publications

(3 citation statements)

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“…Restraints are viewed as “protective” devices although there is no evidence that they are effective in safeguarding patients from injury 4,5 . In‐hospital mortality and morbid events are increased in patients who have been restrained 1–7 . The use of restraints for more than four days has been associated with an increased rate of nosocomial infection and pressure sores 3 .…”

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confidence: 99%

Deciding to Restrain Medical Patients

Macpherson

Lofgren

Granieri

et al. 1990

J American Geriatrics Society

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To determine when and why patients are placed in mechanical restraints, we surveyed the nurse and physician caring for each of 102 restrained patients from the general medical floors of an acute-care hospital. Ninety-three percent of the questionnaires were completed. Nursing questionnaires indicated that over half of patients were restrained during the evening shift. Nurses initiated the use of restraints in 75% of cases. Fifteen percent of the patients' physicians were unaware that the patient had been restrained. In the majority of cases, the nurse and physician believed that restraint was the best alternative for managing the patient although more physicians (11%) than nurses (2%) thought an alternative intervention would be better (P less than .02). As a group, physicians and nurses restrained patients for similar reasons, most often to prevent falls from bed (69%) or to protect medical devices (36%). However, there was poor agreement between the nurse and physician as to the reason for restraint in an individual patient (kappa statistic range from .02 to .43). These findings suggest that nurse and physician communication regarding restraint is poor. We recommend that acute-care hospitals adopt policies to promote communication between nurses and physicians concerning restraints to ensure that use of this potentially hazardous intervention is used only when necessary.

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confidence: 99%

Deciding to Restrain Medical Patients

Macpherson

Lofgren

Granieri

et al. 1990

J American Geriatrics Society

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“…Perceptual and behavioral responses that have been noted with immobilization 8,9,68–71 lend support to these physiologic effects in humans and may account for the disorganized behavior noted among elderly restrained patients. Attempting to restrain a frightened, delirious patient serves to increase the panic and fear of danger that can produce angry, belligerent, or combative behavior 40 , 62 , 72 – 74 . Emotional desolation may result from fear of abandonment or embarrassment of incontinence 14 …”

Section: Effects and Consequencesmentioning

confidence: 99%

“…Warshaw et al 24 report that physical restraints reduce functional capacity as a patient quickly loses steadiness and balance when restricted to a bed or chair. Devices that are too restrictive or too tight can cause problems of elimination, 30 aspiration pneumonia, 62 circulatory obstruction, 63 cardiac stress, 14 skin abrasions or breakdown, 6,44,64 poor appetite and dehydration, 6 and accidental death by strangulation 22 , 25 , 31 , 40 . In addition, an association between the use of physical restraints and death during hospitalization has been shown 14 , 15 , 19 …”

Section: Effects and Consequencesmentioning

confidence: 99%

Tying Down the Elderly

Evans¹,

Strumpf²

1989

J American Geriatrics Society

351

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The apparently widespread practice of physical restraint of the elderly has received little systematic research, despite reported clinical awareness of its iatrogenic effects on frail elders. Prevalence rates in various settings range between 6% and 86%, with cognitive impairment an important risk factor for restraint. Despite strongly held beliefs, efficacy of restraints for safeguarding patients from injury has not been demonstrated clinically. This paper reviews the current status of knowledge regarding physical restraint use with the elderly and suggests a research agenda and implications for ethical practice.

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Care of the Confused Elderly Patient

Cited by 2 publications

References 0 publications

Deciding to Restrain Medical Patients

Deciding to Restrain Medical Patients

Tying Down the Elderly

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