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American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2011 Feb;26(1):44–50. doi: 10.1177/1533317510387585

Physical Restraint Use and Falls in Nursing Homes: A Comparison Between Residents With and Without Dementia

Huabin Luo 1, Michael Lin 2, Nicholas Castle 3
PMCID: PMC10845417  PMID: 21282277

Abstract

Aims: To estimate the use of different types of physical restraints and assess their associations to falls and injuries among residents with and without Alzheimer’s disease (AD) or dementia in US nursing homes. Methods: Data were from the 2004 National Nursing Home Survey. AD or dementia was identified using International Classification of Diseases, Ninth Revision (ICD-9) codes. Analyses were conducted with the Surveyfreq and Surveylogistic procedures in SAS v.9.1. Results: Residents with either AD or dementia were more likely to be physically restrained (9.99% vs 3.91%, P < .001) and less likely to have bed rails (35.06% vs 38.43%, P < .001) than those residents without the disease. The use of trunk restraints was associated with higher risk for falls (adjusted odds ratio [AOR] = 1.66, P < .001) and fractures (AOR = 2.77, P < .01) among residents with the disease. The use of full bed rails was associated with lower risk for falls among residents with and without the disease (AOR = 0.67 and AOR = 0.72, Ps < .05, respectively). Conclusions: The use of a trunk restraint is associated with a higher risk for falls and fractures among residents with either AD or dementia.

Keywords: physical restraints, falls and fractures, dementia, nursing homes

Full Text

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Contributor Information

Huabin Luo, Department of Health Care Management, Tillman School of Business, Mount Olive College, Mount Olive, NC, USA, hluo@moc.edu .

Michael Lin, Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.

Nicholas Castle, Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.

References

  1. Alzheimer’s Association. 2009 Alzheimer’s disease facts and figures. Alzheimers Dement. 2009;5(3):234-270. [DOI] [PubMed] [Google Scholar]
  2. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60(8):1119-1122. [DOI] [PubMed] [Google Scholar]
  3. Smith GE, Kokmen E., O’Brien PC Risk factors for nursing home placement in a population-based dementia cohort . J Am Geriatr Soc. 2000;48(5):519-525. [DOI] [PubMed] [Google Scholar]
  4. Doorn CV, Gruber-Baldini AL, Zimmerman S., et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc. 2003;51(9):1213-1218. [DOI] [PubMed] [Google Scholar]
  5. Sullivan-Marx EM, Strumpf NE, Evans LK, Baumgarten M., Maislin G. Initiation of physical restraint in nursing home residents following restraint reduction efforts. Res Nurs Health. 1999;22(5):369-379. [DOI] [PubMed] [Google Scholar]
  6. Tinetti ME, Liu WL, Ginter SF Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med. 1992;116(5):369-374. [DOI] [PubMed] [Google Scholar]
  7. Evans LK, Strumpf NE Myths about elder restraint. Image J Nurs Sch. 1990;22(2):124-128. [DOI] [PubMed] [Google Scholar]
  8. Sullivan-Marx EM Achieving restraint-free care of acutely confused older adults. J Gerontol Nurs. 2001;27(4):56-61. [DOI] [PubMed] [Google Scholar]
  9. Williams CC, Finch CE Physical restraint: not fit for woman, man, or beast. J Am Geriatr Soc. 1997;45(6):773-775. [DOI] [PubMed] [Google Scholar]
  10. Miles SH, Irvine P. Deaths caused by physical restraints. Gerontologist. 1992;32(6):762-766. [DOI] [PubMed] [Google Scholar]
  11. Marcy-Edwards D. Bed rails. Is there an up side? Can Nurse. 2005;101(1):30-34. [PubMed] [Google Scholar]
  12. Jones AL, Dwyer LL, Bercovitz AR, Strahan GW The national nursing home survey: 2004 overview. Vital Health Stat 13. 2009;13(167):1-155. [PubMed] [Google Scholar]
  13. Luo H., Fang X., Liao Y., Elliott A., Zhang X. Associations of special care units and outcomes of residents with dementia: 2004 national nursing home survey. Gerontologist. 2010;50(4): 509-518. [DOI] [PubMed] [Google Scholar]
  14. Decker FH The relationship of nursing staff to the hospitalization of nursing home residents . Res Nurs Health. 2008;31(3):238-251. [DOI] [PubMed] [Google Scholar]
  15. Gruneir A., Lapane KL, Miller SC, Mor V. Is dementia special care really special? A new look at an old question. J Am Geriatr Soc. 2008;56(2):199-205. [DOI] [PubMed] [Google Scholar]
  16. Rubenstein LZ , Josephson KR, Robbins AS Falls in the nursing home. Ann Intern Med. 1994;121(6):442-451. [DOI] [PubMed] [Google Scholar]
  17. Medicare and Medicaid; requirements for long term care facilities-HCFA. Final rule with comment period. Fed Regist. 1989;54(21):5316-5373. [PubMed] [Google Scholar]
  18. Zinn JS Market competition and the quality of nursing home care. J Health Polit Policy Law. 1994;19(3):555-582. [DOI] [PubMed] [Google Scholar]
  19. Capezuti E. Minimizing the use of restrictive devices in dementia patients at risk for falling. Nurs Clin North Am . 2004;39(3): 625-647. [DOI] [PubMed] [Google Scholar]
  20. Ejaz FK, Folmar SJ, Kaufmann M., Rose MS, Goldman B. Restraint reduction: can it be achieved? Gerontologist. 1994; 34(5):694-699. [DOI] [PubMed] [Google Scholar]
  21. Werner P., Koroknay V., Braun J., Cohen-Mansfield J. Individualized care alternatives used in the process of removing physical restraints in the nursing home. J Am Geriatr Soc. 1994;42(3): 321-325. [DOI] [PubMed] [Google Scholar]
  22. Centers for Medicare and Medicaid Services. Nursing Home Compare. http://www.medicare.gov/NHCompare . Accessed July 26, 2010. [Google Scholar]
  23. Evans LK, Cotter VT Avoiding restraints in patients with dementia: understanding, prevention, and management are the keys. Am J Nurs. 2008. ;108(3):40-49; quiz 50. [DOI] [PubMed] [Google Scholar]
  24. Health Care Financing Administration Medicare Department of Health and Human Services (DHHS). State operations manual provider certification transmittal 20. http://www.cmshhs.gov/manuals/pm_trans/R20SOM.pdf. Accessed January 29, 2010. [Google Scholar]
  25. Tinetti ME, Liu WL, Marottoli RA, Ginter SF Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors. JAMA. 1991;265(4):468-471. [PubMed] [Google Scholar]
  26. Capezuti E. , Maislin G., Strumpf N., Evans LK Side rail use and bed-related fall outcomes among nursing home residents. J Am Geriatr Soc. 2002;50(1):90-96. [DOI] [PubMed] [Google Scholar]
  27. Capezuti E. , Talerico KA, Strumpf N., Evans L. Individualized assessment and intervention in bilateral siderail use. Geriatr Nurs. 1998. ;19(6):322-330. [DOI] [PubMed] [Google Scholar]
  28. Castle NG, Engberg J. The health consequences of using physical restraints in nursing homes. Med Care. 2009;47(11):1164-1173. [DOI] [PubMed] [Google Scholar]
  29. Mion LC, Frengley JD, Jakovcic CA, Marino JA A further exploration of the use of physical restraints in hospitalized patients . J Am Geriatr Soc. 1989;37(10):949-956. [DOI] [PubMed] [Google Scholar]
  30. Werner P., Cohen-Mansfield J., Braun J., Marx MS Physical restraints and agitation in nursing home residents. J Am Geriatr Soc. 1989;37(12):1122-1126. [DOI] [PubMed] [Google Scholar]
  31. Capezuti E. , Evans L., Strumpf N., Maislin G. Physical restraint use and falls in nursing home residents. J Am Geriatr Soc. 1996; 44(6):627-633. [DOI] [PubMed] [Google Scholar]
  32. Capezuti E. , Strumpf NE, Evans LK, Grisso JA, Maislin G. The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci. 1998;53(1):M47-M52. [DOI] [PubMed] [Google Scholar]
  33. Castle NG, Mor V. Physical restraints in nursing homes: a review of the literature since the Nursing Home Reform Act of 1987. Med Care Res Rev. 1998;55(2):139-170; ; discussion 171-136. [DOI] [PubMed] [Google Scholar]
  34. Dunbar JM, Neufeld RR, Libow LS, Cohen CE, Foley WJ Taking charge. The role of nursing administrators in removing restraints. J Nurs Adm. 1997;27(3):42-48. [DOI] [PubMed] [Google Scholar]
  35. Capezuti E. , Wagner LM, Brush BL, Boltz M., Renz S., Talerico KA Consequences of an intervention to reduce restrictive side rail use in nursing homes. J Am Geriatr Soc . 2007;55(3):334-341. [DOI] [PubMed] [Google Scholar]
  36. Hanger HC, Ball MC, Wood LA An analysis of falls in the hospital: can we do without bedrails? J Am Geriatr Soc. 1999;47(5): 529-531. [DOI] [PubMed] [Google Scholar]
  37. Si M., Neufeld RR, Dunbar J. Removal of bedrails on a short-term nursing home rehabilitation unit. Gerontologist. 1999;39(5): 611-614. [DOI] [PubMed] [Google Scholar]
  38. Parker K., Miles SH Deaths caused by bedrails. J Am Geriatr Soc. 1997;45(7):797-802. [DOI] [PubMed] [Google Scholar]
  39. O’Keeffe S., Jack CI, Lye M. Use of restraints and bedrails in a British hospital. J Am Geriatr Soc. 1996;44(9):1086-1088. [DOI] [PubMed] [Google Scholar]
  40. Miles SH Deaths between bedrails and air pressure mattresses. J Am Geriatr Soc. 2002;50(6):1124-1125. [DOI] [PubMed] [Google Scholar]
  41. Healey F., Oliver D. Bedrails, falls and injury: evidence or opinion? A review of their use and effects. Nurs Times. 2009;105(26):20-24. [PubMed] [Google Scholar]
  42. Healey F., Oliver D., Milne A., Connelly JB The effect of bedrails on falls and injury: a systematic review of clinical studies. Age Ageing. 2008;37(4):368-378. [DOI] [PubMed] [Google Scholar]
  43. Evans LK, Strumpf NE Tying down the elderly. A review of the literature on physical restraint. J Am Geriatr Soc. 1989;37(1): 65-74. [DOI] [PubMed] [Google Scholar]

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