Chemical and physical restraint use in the older person
John Ellis Agens
A restraint is a device or medication that is used to restrict a patient’s voluntary movement. Reported prevalence of physical restraint varies from 7.4% to 17% use in acute care hospitals up to 37% in long term care in the United States. Prevalence of 34% psychotropic drug use in long term care facilities in the United States has been reported; but use is decreasing, probably due to regulation. Use of restraints often has an effect opposite of the intended purpose, which is to protect the patient. The risk of using a restraint must be weighed against the risk of not using one, and informed consent with proxy decision makers should occur. Comprehensive nursing assessment of problem behaviours, a physician order when instituting restraints, and documentation of failure of alternatives to restraint is required. Ignorance about the dangers of restraint use results in a sincere, but misguided, belief that one is acting in the patient’s best interest.Steps can be taken to reduce restraints before the need for restraints arises, when the need for restraints finally does arise, and while the use of restraints is ongoing.
Keywords: physical restraint, chemical restraint, aged care, antipsychotic agents, therapeutic use, psychotropic agents, treatment outcome, regulations