Anna Liachenko, BSc, MSc
Geriatrics & Aging
Ensuring the safety of nursing home residents is a high priority for both families and health care personnel. To this end, various types of restraints have traditionally been used to protect residents from falls and injuries. Ironically, there is little documented evidence that restraints either prevent falls, or decrease the risk of injury from falls. In fact, studies demonstrate that restraints may precipitate or heighten this risk. In the United States, the Omnibus Budget Reconciliation Act of 1987 (OBRA-87) was passed in response to a host of consumer complaints in addition to state and federal reports criticizing nursing home quality. As part of the reforms, a restriction has been placed on the use of restraints. In the ensuing thirteen years there has been a 50% reduction in the use of restraints and, interestingly, also a significant reduction in the incidence of fall-related injuries. It is not clear whether Canadian nursing homes overuse restraints. Progressive institutions are currently moving towards reducing the use of restraining measures. It is crucial that physicians take into consideration the potential hazards of restraints when evaluating the management of an elderly patient.
Restraints have traditionally been categorized as either chemical or physical.