Outcomes of nighttime physical restraint removal for severely impaired nursing home residents

Abstract

There is ample evidence that physical restraint reduction does not lead to increased falls or injuries. This study tests the effect of removing nighttime restraints by comparing two groups: Restrained in bed at pre- but not postintervention (n = 51), or restrained in bed at both pre- and post-intervention (n = 11). No differences in nighttime fall rates between the two groups were detected. Nighttime physical restraint removal does not lead to increases in falls from bed in older nursing home residents. Although markedly reduced in nursing homes, restraint use remains a common practice among hospitalized older adults. We should continue to focus efforts on developing new, individualized approaches to reduce risk of falling from bed among frail elders.

Interventions for preventing falls in older people in care facilities and hospitals

“…A post-hoc subgroup analysis based on high, intermediate or mixed levels of nursing care showed a statistical difference between subgroups, with a reduction in falls in high- and intermediate-level care facilities, but not in studies or facilities with a mixed level of care. As there is no clear external evidence that could explain these subgroup results, and the finding is not completely consistent across studies, the finding is not considered credible (Guyatt 2011a), and no conclusion based on these subgroups is made. Subgroup analysis by level of cognition did not explain the heterogeneity.…”

“…There is moderate credibility for this post-hoc subgroup analysis (Guyatt 2011a); however, we are uncertain of the effectiveness of this intervention in reducing the rate of falls as the quality of the evidence has been assessed as very low. Due to the contrast between the effectiveness of providing this intervention as a single intervention and its effectiveness when provided as a multifactorial intervention targeted at cognitively intact participants (Hill 2015; which further supports the credibility of the result found in the subgroup analysis within Haines 2011), no conclusion on the effectiveness of this intervention when delivered as a single intervention is made as this is likely to result in difficulty in interpretation.…”

Physical restraint use among nursing home residents: A comparison of two data collection methods

“…Restrictive siderails, defined as two raised full-length siderails [24], were considered as an intermediate measure and analyzed separately because they are frequently used to prevent bed-related falls during nighttime in long-term care settings [25]. …”

Side Rail Use and Bed‐Related Fall Outcomes Among Nursing Home Residents

“…Thus, 144 subjects of the 463 were excluded due to variation in side rail status (n = 80) or any use of nighttime physical restraint (n = 64) during the 1‐year data collection period. The latter group was excluded because nighttime physical restraints were used to prevent bed‐related falls, although such restraint use does not decrease the risk of bed‐related falls 4 …”