Newswise — A recent Cochrane review reveals that reducing the use of physical restraints on care home residents is possible without increasing the risk of falls, especially when frontline care staff receive support and empowerment from their managers.
Physical restraints, which limit residents' freedom of movement, are commonly employed in residential care homes, including nursing homes and assisted living facilities. Examples of such restraints include bed rails or belts that prevent residents from getting out of bed without assistance. However, these practices raise ethical concerns, particularly when used on individuals with dementia, who may be unable to provide informed consent.
Physical restraints are often employed to prevent falls and related injuries, but the benefits are generally minimal and accompanied by significant negative consequences. Limiting movement can adversely affect physical functioning and mobility, ultimately increasing the risk of falls and care dependence. Moreover, these measures can evoke fear and provoke aggressive behavior in some individuals. Due to these concerns, guidelines and experts strongly advocate against using physical restraints in residential care settings.
Implementing this recommendation in practice requires a thoughtful approach. A Cochrane Review, initially published in 2011 and recently updated to incorporate the latest research findings, delves into the scientific evidence concerning interventions and strategies to reduce restraint use. Ralph Möhler from the University Hospital Düsseldorf led the team of authors who examined 11 studies involving a total of 19,003 participants, each evaluating various intervention approaches.
During their evaluation, the authors of the Cochrane Review identified organizational interventions as having the strongest evidence. These interventions were examined in four studies involving a total of 17,954 participants. Organizational interventions aim to reduce the use of restraints by implementing a comprehensive set of components. These initiatives focus on enhancing the knowledge, skills, and strategies of frontline care staff and managers to prevent the use of restraints.
In three of the studies, certain employees were designated as 'champions' and received specialized training to develop and implement individualized strategies for restraint prevention within their respective facilities. Managers provided support by relieving these champions of other duties and ensuring they had sufficient time to carry out their tasks effectively.
The implementation of these interventions likely results in a 14% decrease in the number of nursing home residents subjected to physical restraints. However, there were no significant changes observed in the overall number of residents experiencing falls or fall-related injuries, nor was there any increase in the prescription of psychotropic medications. Furthermore, no adverse effects of the interventions were reported.
Based on the study data, the authors projected that by applying these interventions, the number of residents with physical restraints could potentially be reduced from 274 to 236 per 1000 individuals. This highlights the significance of focusing on organizational-level changes to achieve sustainable and long-term effects in care homes.
Six studies investigated educational interventions aimed at addressing staff knowledge and attitudes concerning the use of restraints. However, the outcomes of these studies were inconsistent, and some of them had methodological limitations. As a result, a definitive conclusion regarding the effects of educational interventions cannot be reached at this time.
Ralph Möhler, the lead author of the review, stated, "The results of this review demonstrate that it is possible to reduce the use of physical restraints in nursing homes without increasing the occurrence of falls or fall-related injuries. The reviewed studies did not provide evidence of an increased prescription of psychotropic medications. However, it appears that education for frontline staff alone may not be sufficient; the support and involvement of care home managers play a crucial role in achieving successful outcomes."
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