Health Facilities

Restraints Have Risks -- Make the Right Choice

From childhood on, one of the most important impulses is to maintain independence through movement.

As people age, their ability to move is compromised by the natural processes of aging. For people who reside in nursing homes, it was thought for many years that using "restraints"--devices that prevent people from moving around — would ensure safety from falls and other dangers.

Today, restraints are used much less frequently because studies have shown they can be dangerous. Nursing homes and health care agencies are working hard to reduce the use of restraints. Inside is information we would like you to consider.

What Is a Physical Restraint?

A physical restraint is anything near or on the body which restricts movement. Some examples of physical restraints are:

• Lap buddies, belts, "geri" chairs, vests, or trays, which keep the body immobile in a wheelchair,
• Bed rails or belts, which keep people confined to their beds, and
• Door alarms, which prevent people from walking beyond a set point

What Are Chemical Restraints?

A chemical restraint is a medication given to control behavior such as striking out or yelling. Chemical restraints include sedatives and antipsychotic drugs. These have many appropriate uses as prescribed by a physician to treat specific conditions caused by mental illness. Using these drugs for problems like pacing, wandering, restlessness, or uncooperative behavior is often inappropriate.

Restraints May Be Used to:

• Prevent falls
• Reduce wandering
• Minimize behavior problems
• Respond to medical necessity

The restraints question is not an "all or nothing" issue. Some devices can be used appropriately to enable the individual to maintain certain functions. For example, a lap buddy can be used as a tray for reading or other activities. When restraints must be used, the least restrictive device that promotes the highest level of functioning for the individual should be chosen.

Dangers Associated with Restraints

Possible physical effects of the inability to move freely include:

• Decreased bone/muscle strength
• Decreased appetite and malnutrition
• Dehydration
• Pneumonia
• Urinary tract infections
• Constipation
• Incontinence
• Pressure sores and/or bruising
• Death by asphyxiation

Possible mental or emotional effects of using restraints include:

• Agitation
• Depression/withdrawal
• Loss of dignity
• Sleeping problems
• Humiliation

Bed Rails Can Be a Risk

• Bed rails can increase the risk of injury to the elderly. People must be appropriately assessed to ensure correct use of bed rails.
• Bed rails do not prevent all falls. People sometimes climb over their rails, often to get to the toilet. When people climb over their bed rails and fall, the height of the fall is greater and, therefore, so is the risk of injury.
• Elderly people with decreased strength can become trapped between their bed rail and their mattress.
• Before using bed rails, consider alternatives such as lowered beds, futons, or waterbeds.

If You or a Relative Live in a Nursing Home...

• Know that restraints may only be used to treat specific medical symptoms
• Participate in care planning and ask how the restraint, if being considered, will help the resident function.
• Be involved when decisions are made regarding the use of restraints.
• When deciding whether restraint use is appropriate, consider the alternatives first and ask questions of health care providers and nursing home staff.

Here are some options for you and the nursing home to consider prior to using restraints:

• Try non-restraining positioning devices
• Increase social opportunities
• Provide physical and massage therapy
• Conduct medication review
• Lower beds
• Encourage family/volunteer involvement
• Provide entertaining activities
• Continuously assess individual needs

The Benefits of Keeping People Mobile Longer:

• Preservation of dignity

• Greater sense of well-being and independence

• Greater muscle strength

• Independence with regard to eating, toileting, dressing, and walking

• Greater self-esteem

• Ability to interact with environment

Things you can do to prevent falls in the home:

Because falls are a major cause of nursing home admissions, consider modifying the home environment to decrease the risk of falling. A few suggestions include:

• Remove throw rugs, electrical cords, and other items that can cause an elderly person to trip and fall.
• Install railing and/or hand grips to help seniors move around safely.
• Determine whether poor vision or side effects of medications may be putting an elderly person at increased risk for falling.
• Provide shoes that fit properly.
• Ensure adequate lighting in all rooms.
• Avoid wet or slippery floors.

For a home risk assessment, contact a public health nurse or your county health department. If you are using a home health agency, contact that agency for a home risk assessment.

If you would like more information about restraints, please contact:

Colorado Department of Public Health and Environment
Health Facilities and Emergency Medical Services Division
4300 Cherry Creek Drive South
Denver, CO. 80246
(303) 692-2800

Colorado Long Term Care Ombudsman Program
455 Sherman Street, Suite 130
Denver, CO. 80203
(303) 722-0300 (Denver Metro)
(800) 288-1376

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