J Korean Geriatr Psychiatry.  2005 Dec;9(2):102-107.

Troubles during Dementia Management : Geropsychiatric Restraints

Affiliations
  • 1Department of Neuropsychiatry, Kosin University College of Medicine, Busan, Korea. cheonjs@mail.kosin.ac.kr

Abstract


OBJECTIVES
The use of physical restraints for the geropsychiatric patients has been underreported to decrease in recent years. The aims of this study were to investigate frequency of restraints, to identify predictors and reasons for restraint use with geropsychiatric patients, to evaluate restraint related risks, and to suggest care alternatives used in restraint reduction.
METHODS
English literatures published during 1990 thru 2005 were searched using internet and were reviewed.
RESULTS
1) Prevalence of restraint use in nursing homes was 25-85%. Incidence rate of restraints in geriatric ward of psychiatric hospital was 27.1%, which was 10.6 times more for the dementia patients. 2) Predictors of restraint use with geropsychiatric patients were older age, cognitive impairment, disruptive behaviors, impaired mobility and history of falls. Two variables most likely to affect fall and safety risk were cognitive function and ambulatory status. 3) Restrained patients were significantly more demented, show more safety judgement problems, and have a much higher overall risk for injury. 4) Five care alternatives to replace restraints are environmental care alternatives, alterations in nursing care, activities, physiological alternatives, and psychosocial alternatives.
CONCLUSION
Physical restraints cannot just be removed. Care alternatives should be implemented to protect patient's safety. This is the beginning for the provision of safe care in a dignified and less restrictive environment that will promote or maintain patient's abilities.

Keyword

Physical restraints; Cognitive impairment; Impaired mobility; Care alternatives
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