Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

Nakanishi, Miharu; Okumura, Yasuyuki; Ogawa, Asao

doi:10.1017/s104161021700240x

Cited by 32 publications

(35 citation statements)

References 29 publications

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“…6,30 However, physical restraints should be avoided, wherever possible, in conformance with recommendations that have been issued worldwide, including in Japan. [14][15][16][17] We considered the following two major reasons for the increased use of physical restraints in elderly dementia patients compared with recent trends in the previous year: 1) patient factors and 2) factors associated with the care system.…”

Section: Discussionmentioning

confidence: 99%

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

Okuno

Shin

Takada

et al. 2020

Preprint

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Background: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for medical staff worldwide, especially for those working in hospitals in which COVID-19-positive or -suspected patients are being treated. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, that could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.Methods: In this retrospective cohort study, we extracted the data of elderly patients (age >65 years) who received dementia care in acute care hospitals to which COVID-19-positive or -suspected patients were admitted between July 1, 2018 and June 30, 2020. We calculated descriptive statistics to compare the year-on-year trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.Results: The year-on-year trend in the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement of COVID-19 restrictions, with a maximum incidence of 111.4% between the 47th and 48th week after the announcement. Additionally, a significant increase in the use of physical restraints in elderly dementia patients was noted (p=.002).Conclusions: Elderly dementia patients who required personal care experienced an obvious and significant increase in the use of physical restraints during the COVID-19 pandemic. Understanding the causes and mechanisms underlying an increased use of physical restraints in dementia patients can help design more effective care protocols for similar future situations.

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Section: Discussionmentioning

confidence: 99%

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

Okuno

Shin

Takada

et al. 2020

Preprint

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“…36 The use of physical and chemical restraints has not only shown to be ineffective but may result in adverse events for patients, caregivers, and staff, as well as regulatory challenges. 37,38 Figure 3. Frequency of constant observation use for selected conditions, percentage of respondents answering "often" or "very often" according to position.…”

Section: Discussionmentioning

confidence: 99%

Constant Observation Practices for Hospitalized Persons With Dementia: A Survey Study

Sinvani

Strunk

Patel

et al. 2019

Am J Alzheimers Dis Other Demen

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Despite substantial staffing and cost implications, the use of constant observation (CO) has been poorly described in the acute care setting. The purpose of this cross-sectional, multicenter, survey study was to assess hospital provider practices regarding the use of CO. Of the 543 surveys distributed, 231 were completed across 5 sites. Most respondents worked on medical units (67.5%), as nurses (49.1%); 44.8% were white; and 75.6% were female. The majority (84.2%) reported at least 1 patient/wk requiring CO. Most frequent indication for CO was dementia with agitation (60.7%), in patients older than 70 (62.3%) and predominantly by nurse assistants (93.9%). Almost half (47.3%) stated they felt pressured to discontinue CO, despite a strong perceived benefit (76%). Enhanced observation (92.6%) was most frequently used to decrease CO. Finally, 77.9% perceived that those performing CO lacked training. Our study highlights the widespread use of CO for hospitalized older adults with dementia.

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“…In a cross-sectional study of all public and private nursing homes in Malta, Fenech (2016) indicated that staff working in these homes reported a high observed incidence of physical restraints. Nakanishi, Okumura & Ogawa (2018), found that among patients with dementia admitted to acute hospitals, the point prevalence of physical restraints was as high as 44.5%. This high prevalence has been attributed to the priority given by hospital staff perceptions around patient safety and risks associated with 'wandering' or falls, at the expense of the patient's esteem needs for dignity and autonomy (Digby, Lee & Williams, 2017).…”

Section: Discussionmentioning

confidence: 99%

The perceived and observed needs of patients with dementia admitted to acute medical wards

Scerri

Innes

2018

Dementia

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Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

Cited by 32 publications

References 29 publications

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

Constant Observation Practices for Hospitalized Persons With Dementia: A Survey Study

The perceived and observed needs of patients with dementia admitted to acute medical wards

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Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

Cited by 32 publications

References 29 publications

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the&nbsp;COVID-19 Pandemic: A Cohort Analysis in Japan

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the&nbsp;COVID-19 Pandemic: A Cohort Analysis in Japan

Constant Observation Practices for Hospitalized Persons With Dementia: A Survey Study

The perceived and observed needs of patients with dementia admitted to acute medical wards

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Product

Resources

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Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan