Use of physical restraints and antipsychotic medications in nursing homes: a cross‐national study

Abstract

SUMMARY Objectives This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments. Methods Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries. Results The prevalence of physical restraint use varied more than five-fold across the study countries, from an average 6% in Switzerland, 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada. The prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26–27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed across facilities in both physical restraint and antipsychotic use rates. In all countries, neither facility case mix nor organizational characteristics were particularly predictive of the prevalence of either treatment. Conclusions There exists large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries. Since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the idiosyncratic factors specific to each country that contribute to variation in use rates.

Antipsychotic prescribing to older people living in care homes and the community in England and Wales

“…Notably, the overall rate seems to have changed little in the last twenty years. Our national rate is similar or lower than rates reported in larger international studies in care homes in the US, Canada, Sweden, Finland, Switzerland and Australia and confirms that antipsychotic prescribing in care homes is not a parochial problem for the UK healthcare system but a challenge for all developed populations (Kamble et al, 2008;Lövheim et al, 2008;Rochon et al, 2007;Snowdon et al, 2005;Feng et al, 2009). Community prescribing is less well described and gender, regional and socio-economic differences have not been examined before.…”

Use of Physical Restraints in a Rehabilitation Setting: Findings from a Point Prevalence Survey

“…Similar to the report of Hamers et al [23], patients with a history of stroke and a diagnosis related to cognitive impairment comprised a large percentage of the restrained patients in our study. Age was often reported to be one of the predictors of physical restraint usage in studies [33]. Locally, Kwok et al (2006) observed that around 79% of older adults in his sample were restrained at one time or another during their hospital stay [34].…”

“…A multitude of physiological changes such as catecholamine rush, breakdown of muscle cells, pulmonary embolism, thrombophlebitis and psychological effects such as nightmares, intrusive thoughts, and avoidance responses have also been observed to result from restraint use [11]. Further, potential negative outcomes include increased incidence of falls, contractures, nosocomial infection, pressure ulcers, psychiatric morbidity, mental health problems, aggressive behavior, and mortality [12].…”

Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Physical restraint use in older people

“…Rates of use in older people in European residential care facilities have been reported to be between 6 and 40%, with the higher rates thought to be due to the abundance of studies focusing on residents with dementia [4,9,[16][17][18]. US rates appear to have fallen over the years, with reports of prevalence of around 5% in acute settings and 9-30% in residential care settings [14,16,19].…”