Fewer Nursing Home Residents Being Physically Restrained

Megan Brooks

July 22, 2010

July 22, 2010 — The number of US residents in nursing homes who are kept physically restrained dropped by more than half from 1999 to 2007, according to a News and Numbers report from the Agency for Healthcare Research and Quality (AHRQ), part of the 2009 National Healthcare Disparities Report.

"These are annual reports mandated by Congress on trends across the nation on the quality of healthcare provided to the American people," Karen K. Ho, MHS, research analyst with the Center for Quality Improvement and Patient Safety at AHRQ in Rockville, Maryland, told Medscape Medical News. "One area the AHRQ focuses on is nursing homes."

According to the report, the number of nursing home residents kept physically restrained fell overall from roughly 11% in 1999 to 5% in 2007. Restraints include belts, vest and wrist ties or bands, or special chairs or bedside rails.

Long-Stay Nursing Home Residents Who Were Physically Restrained, United States, 1999 and 2007

Population Group 2007 1999
% SE % SE
Total 4.99 0.02 10.72 0.03
Age (years)
 0 - 64 4.68 0.05 12.55 0.09
 65 - 74 4.09 0.05 9.41 0.07
 75 - 84 5.12 0.04 10.81 0.05
 85 and older 5.27 0.03 10.63 0.04
Sex
 Male 4.84 0.04 10.64 0.05
 Female 5.06 0.02 10.76 0.03
Race/ethnicity
 Non-Hispanic, White 4.95 0.02 10.61 0.03
 Non-Hispanic, Black 4.46 0.05 10.08 0.08
 Non-Hispanic, AI/AN 5.97 0.31 10.20 0.37
 Non-Hispanic, API 6.80 0.18 15.65 0.32
 Hispanic, all races 6.95 0.11 15.42 0.19

AI/AN: American Indian or Alaska Native; API: Asian or Pacific Islander; SE: standard error. Source: Centers for Medicare & Medicaid Services, Minimum Data Set.

The report also found that the percentage of Asian/Pacific Island and Hispanic nursing home residents who were restrained physically declined from about 16% in 1999 to about 7% in 2007.

Disparity Between Asian and White Populations

"There is disparity between the Asian populations compared with the white population," Ms. Ho commented. "Asians and Hispanics are more likely to be restrained when they are in a nursing home." The report doesn't go into the why, but some of the literature suggests that language is an important aspect of quality of care, she added.

"The ability to communicate with your provider and the provider's ability to communicate with the patient is really important, and when you have problems communicating you're less likely to get the care that you want — or even the care that is recommended. That's one possible explanation," Ms. Ho said.

Black nursing home residents were the least likely to be physically restrained in both 1999 and 2007 (10% and 4%, respectively).

Use of physical restraints among American Indian/Alaska Native and white residents also declined by roughly half (from just over 10% to 6% and from just over 10% to 5%, respectively).

A written statement from AHRQ notes that overuse of physical restraints "may reflect poor quality of care because residents who are restrained daily can become weak and lose daily functioning abilities. They are also more prone to sores and other problems, such as chronic constipation or incontinence as well as emotional problems."

Perspective From the American Nurses Association

In an interview with Medscape Medical News, Cheryl A. Peterson, MSN, RN, director, Nursing Practice & Policy, American Nurses Association, in Silver Spring, Maryland, said: "We certainly agree with the sentiment that restraints should only be used when there is no other viable option; that is first and foremost our perspective.

"It would be nice," she said, "to see some differentiation by illness, given, for example, the number of dementia patients that we have in this country, the need for restraint in these cases, and how that is being managed or not managed well. That would be helpful."

"Unfortunately," Ms. Ho said, "we don't have data in the report on use of physical restraints by illness (ie, dementia, psychiatric illness)."

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