| During the past two decades, significant research and several government and health care
quality groups have advised against the use of physical restraints in hospitals and nursing homes, yet
older adults are continuing to die, become injured or experience the iatrogenic complications associated
with this practice. Deaths are usually caused by asphyxiation, but also occur from strangulation,
or cardiac arrest. Older adults with dementia are at high risk for restraint use because of impaired
memory, language, judgment and visual perception. In moderate to severe dementia, the risk of falls is
greater because of gait apraxia and unsteadiness. Agitation, disorientation, and pacing behaviors from
delirium or dementia can precipitate staff to use restraints to prevent harm to the older adult or to
others. Physical restraints should be eliminated as an intervention in older adults with dementia
because they are also very likely to cause acute functional decline, incontinence, pressure ulcers and
regressive behaviors in a short period of time. The purpose of this paper is to disseminate the dangers
of this clinical practice and to summarize the latest research in restraint free care and restraint alternatives
in the United States. |
