PREDICTORS OF RESTRAINT USE IN NURSING HOME RESIDENTS FOLLOWING INTERVENTIONS TO REDUCE RESTRAINTS.

Description

Based on evidence of negative effects and limited efficacy of physical restraint of older adults, efforts to eliminate physical restraint use in nursing homes in the United States coalesced in federal legislation (Nursing Home Reform Law) implemented in 1990. Despite diverse attempts, such as policy mandates, education, or intensive nursing and system efforts, use of physical restraints in U.S. nursing homes in 1992 still exceeded that of other Western countries. This study was a secondary analysis of an existing data set developed to test the effects of interventions designed to reduce restraint use in nursing homes. The present study examined predictors of restraint use in those nursing home residents who were either continuously or newly restrained following interventions aimed at restraint reduction. Using a one group pre-test post-test design, contextual factors and resident characteristics known to be associated with restraint use were examined to establish predictors of continued and initiated restraint use employing logistic regression analysis. Of the nursing home residents restrained prior to interventions (N = 201), 135 (67.2%) were still restrained following the interventions. Lower cognitive status (odds ratio:2.4, 95% CI:1.7, 3.3) and fall risk as reason for restraint (odds ratio:3.5, 95% CI:1.5, 8.0) were predictive of continued restraint use. Of the nursing home residents not restrained prior to the interventions (N = 335), 23 (6.9%) were newly restrained. Lower cognitive status (odds ratio:1.5, 95% CI:1.0, 2.1) and a greater ratio of licensed nursing personnel (predominantly licensed practical nurses) to non-licensed nursing personnel (odds ratio:3.7, 95% CI:1.2, 11.9) were predictive of initiation of restraint use. Key findings of the study suggest that continued restraint use in nursing homes occurs with residents who are severely cognitively impaired and when staff believe the resident to be at risk for falling, despite a lack of objective verification of fall risk. Initiation of restraint use following interventions is a less common event but occurs when a nursing home resident is cognitively impaired and when staff mix has a greater proportion of licensed (particularly licensed practical nurses) than non-licensed nursing personnel.

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