Comparisons of Restraint Use in Nursing Homes in Eight Countries

Abstract

Background: the use of restraints in nursing homes varies among countries and institutions. However, in many countries, no reliable data exist, although restraints use is acknowledged. Method: we compare data of the type of restraints used (trunk, limb or chair that prevents rising) and the intensity of its use in eight countries: Denmark, France, Iceland, Italy, Japan, Spain, Sweden and the USA. We report these data in total and for groups of residents with similar functional abilities and cognitive performance, thus avoiding to a certain extent the case-mix differences between samples from different countries. Results: the total use of restraints in these cross-sectional samples showed a very low prevalence in Denmark, Iceland and Japan (less than 9%). Between 15 and 17% were seen in France, Italy, Sweden and the USA, while Spain showed almost 40%. These major differences among the countries persist, even when one controls for physical and cognitive abilities. There are also differences in the types and intensity of restraints used in different countries. In all countries, there is a constant increase in use of restraints with increasing activities of daily living difficulties and cognitive dysfunction.

Mental Health Outcomes and Physical Restraint Use in Nursing Homes {Private}

“…Restraint use may be much higher at night when staffing levels are lower. Physical restraint use is substantially lower among nursing homes in many other developed countries, ranging from 2 to 9% of facility residents (Ljunggren, Phillips, & Sgadari, 1997). This, and the fact that restraint use rates in U.S. nursing homes vary widely, suggests that many facilities here could function with lower rates of use than are currently employed.…”

Use of constraints and surveillance in Norwegian wards for the elderly

“…In most of these a strict definition has been applied (Capezuti et al, 1996;Fletcher, 1996;Karlsson et al, 1996;Ljunggren et al, 1997;Castle and Mor, 1998;Retsas, 1998;Sullivan-Marx et al, 1999;Castle, 2000), limiting the studies to actions like the restriction of movement or normal access to the body, or to the use of mechanical devices. A few studies include chemical restraints (Fletcher, 1996).…”

Treatment strategy and risk of functional decline and mortality after nursing‐home acquired lower respiratory tract infection: two prospective studies in residents with dementia

“…A Dutch study on cognitively impaired residents found 32% were regularly restrained (Hamers et al, 2004). Ljunggren found prevalence as high as 40% across several nations (Ljunggren et al, 1997).…”