Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

Published In: The Gerontologist, v. 48, no. 4, Aug. 2008, p. 442-452

Posted on RAND.org on December 31, 2007

by John Engberg, Nicholas G. Castle, Daniel F. McCaffrey

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PURPOSE: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental health. DESIGN AND METHODS: The authors used all nursing homes (N = 740) in Pennsylvania in 2001, with 12,820 residents. They used the Minimum Data Set data; Online Survey, Certification and Reporting data; and the Area Resource File as data sources. The authors restricted our sample to newly admitted nursing home residents who were not restrained in the first two quarters of their residency. The authors examined which facility and individual characteristics during those first two quarters were associated with restraint initiation during the third quarter. We then examined the association of third-quarter restraint initiation with fourth-quarter health outcomes, using regressions that controlled for first- and second-quarter health status as well as other resident, facility, and market characteristics. The physical health outcomes examined consisted of falls, walking dependence, activities of daily living (ADLs), pressure ulcers, and contractures. Mental health outcomes examined consisted of cognitive performance, depression, and behavior problems. RESULTS: The initiation of restraint use was associated with a previous fall (p <.01), psychoactive medication use (p <.05), low cognition (p <.01), ADL scores (p <.01), and the absence of pressure ulcers (p <.10), as well as a variety of facility characteristics. Subsequent to restraint initiation, we found an association with lower cognitive performance (p <.01), lower ADL performance (p <.01), and higher walking dependence (p <.01). IMPLICATIONS: The authors found that an association between restraint initiation and subsequent adverse health consequences exists and is substantial. Moreover, these results would appear to have practical as well as statistical significance.

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