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January 23, 1991, Vol 265, No. 4 >
ARTICLE | January 23, 1991

Mechanical Restraint Use Among Residents of Skilled Nursing Facilities: Title and subTitle BreakPrevalence, Patterns, and Predictors FREE

Mary E. Tinetti, MD; Wen-Liang Liu, MPH; Richard A. Marottoli, MD; Sandra F. Ginter, RN-C
[+] Author Affiliations

Reprint requests to Department of Internal Medicine, 333 Cedar St, PO Box 3333, New Haven, CT 06510-8056 (Dr Tinetti).


JAMA. 1991;265(4):468-471. doi:10.1001/jama.1991.03460040044026
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References

The patterns of and risk factors for mechanical restraint use were determined in 12 skilled nursing facilities. Restraints were being used for 59% of residents at the beginning of the study; 31% of remaining residents were restrained during the follow-up year. No facility characteristic was associated with restraint use. The resident characteristics independently associated with initiation of restraints were older age, disorientation, dependence in dressing, greater participation in social activities, and nonuse of antidepressants. Unsteadiness (72%), disruptive behavior such as agitation (41%), and wandering (20%) were the most frequently cited reasons for initiation of restraints.

(JAMA. 1991;265:468-471)

REFERENCES

1 +
Blakeslee J.  Untie the elderly . Am J Nursing. 1988;;88:833-834.
2 +
 Rules and regulations . Federal Register . 1989;;54:5317-5318.
3 +
 Husband sues hospital for death of wife after fall . Citation . 1985;;50:81.
4 +
Creighton H.  Are siderails necessary? Nurs. Managment . 1982;; 13:45-48.
5 +
 Cotsides: protecting whom from what? Lancet . 1984;;35:383-384. Editorial.
6 +
Francis J.  Using restraints in the elderly because of fear of litigation . N Engl J Med. 1989;;320:870-871.
7 +
Halpert A, Connors JP.  Prevention of patient falls through perceived control and other techniques . Law Med Health Care . 1986;;14:20-24.
8 +
Evans LK, Strumpf NE.  Tying down the elderly: a review of the literature on physical restraint . J Am Geriatr Soc. 1989;;37:65-74.
9 +
Dube AH, Mitchell EK.  Accidental strangulation from vest restraints . JAMA . 1986;;256:2725-2726.
10 +
McLardy-Smith P, Burge PD, Watson NA.  Ischemic contracture of the intrinsic muscles of the hands: a hazard of physical restraint . J Hand Surg. 1986;;11:65-67.
11 +
Robbins LJ, Boyko E, Lane J, Cooper D, Jahnigen D.  Binding the elderly: a prospective study of the use of mechanical restraints in an acute care hospital . J Am Geriatr Soc. 1987;;35:290-296.
12 +
Lofgren RP, MacPherson DS, Grenieri R, Myllenbeck S, Sprafka JM.  Mechanical restraints on the medical wards: are protective devices safe? Am J Public Health. 1989;;79:735-738.
13 +
Werner P, Cohen-Mansfield J, Braun J, Marx MS.  Physical restraints and agitation in nursing home residents . J Am Geriatr Soc. 1989;;37:1122-1126.
14 +
Strumpf NE, Evans LK.  Physical restraint of the hospitalized elderly: perceptions of patients and nurses . Nurs Res. 1988;;37:132-137.
15 +
Evans LK, Strumpf NE.  Patterns of restraint: a cross-cultural view . Gerontologist . 1987;;27: 272-273. Abstract.
16 +
Special Committee on Aging—US Senate. Untie the Elderly: Quality Care Without Restraints. Washington, DC: US Government Printing Office; 1990. Serial No. 101-H.
17 +
Mion LC, Frengley JD, Jakovcic DA, Marino JA.  A further exploration of the use of physical restraints in hospitalized patients . J Am Geriatr Soc. 1989;;37:949-956.
18 +
Powell C, Mitchell-Pederson L, Fingerote E, Edmund L.  Freedom from restraint: consequences of reducing physical restraints in the management of the elderly . Can Med Assoc J. 1989;;141:561-564.
19 +
Tinetti ME, Ginter SF.  The Nursing Home Life-Space Diameter: a measure of extent and frequency of mobility among nursing home residents J Am Geriatr Soc. In press.
20 +
SAS Institute Inc.SAS/STAT User's Guide, Release 6.03 Edition . Cary, NC: SAS Institute Inc; 1988;:189-282.
21 +
Tinetti M.  Factors associated with serious injury during falls by ambulatory residents . J Am Geriatr Soc. 1987;;35:644-648.
22 +
Masters R, Favro Marks S.  The use of restraints . Rehabilitation Nurs. 1990;;15:22-25.
23 +
Tinetti ME, Williams TF, Mayewski R.  A fall risk index based on number of chronic disabilities . Am J Med. 1986;;80:429-434.
24 +
Rader J, Doan J, Schwab M.  How to decrease wandering: a form of agenda behavior . Geriatr Nurs. 1985;;6:196-199.
25 +
Rader J.  A comprehensive staff approach to problem wandering . Gerontologist. 1987;;27: 756-760.
26 +
Hussein RA, Brown DC.  Use of two-dimensional grid patterns to limit hazardous ambulation in demented patients . J Gerontol. 1987;;42:558-560.

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1 +
Blakeslee J.  Untie the elderly . Am J Nursing. 1988;;88:833-834.
2 +
 Rules and regulations . Federal Register . 1989;;54:5317-5318.
3 +
 Husband sues hospital for death of wife after fall . Citation . 1985;;50:81.
4 +
Creighton H.  Are siderails necessary? Nurs. Managment . 1982;; 13:45-48.
5 +
 Cotsides: protecting whom from what? Lancet . 1984;;35:383-384. Editorial.
6 +
Francis J.  Using restraints in the elderly because of fear of litigation . N Engl J Med. 1989;;320:870-871.
7 +
Halpert A, Connors JP.  Prevention of patient falls through perceived control and other techniques . Law Med Health Care . 1986;;14:20-24.
8 +
Evans LK, Strumpf NE.  Tying down the elderly: a review of the literature on physical restraint . J Am Geriatr Soc. 1989;;37:65-74.
9 +
Dube AH, Mitchell EK.  Accidental strangulation from vest restraints . JAMA . 1986;;256:2725-2726.
10 +
McLardy-Smith P, Burge PD, Watson NA.  Ischemic contracture of the intrinsic muscles of the hands: a hazard of physical restraint . J Hand Surg. 1986;;11:65-67.
11 +
Robbins LJ, Boyko E, Lane J, Cooper D, Jahnigen D.  Binding the elderly: a prospective study of the use of mechanical restraints in an acute care hospital . J Am Geriatr Soc. 1987;;35:290-296.
12 +
Lofgren RP, MacPherson DS, Grenieri R, Myllenbeck S, Sprafka JM.  Mechanical restraints on the medical wards: are protective devices safe? Am J Public Health. 1989;;79:735-738.
13 +
Werner P, Cohen-Mansfield J, Braun J, Marx MS.  Physical restraints and agitation in nursing home residents . J Am Geriatr Soc. 1989;;37:1122-1126.
14 +
Strumpf NE, Evans LK.  Physical restraint of the hospitalized elderly: perceptions of patients and nurses . Nurs Res. 1988;;37:132-137.
15 +
Evans LK, Strumpf NE.  Patterns of restraint: a cross-cultural view . Gerontologist . 1987;;27: 272-273. Abstract.
16 +
Special Committee on Aging—US Senate. Untie the Elderly: Quality Care Without Restraints. Washington, DC: US Government Printing Office; 1990. Serial No. 101-H.
17 +
Mion LC, Frengley JD, Jakovcic DA, Marino JA.  A further exploration of the use of physical restraints in hospitalized patients . J Am Geriatr Soc. 1989;;37:949-956.
18 +
Powell C, Mitchell-Pederson L, Fingerote E, Edmund L.  Freedom from restraint: consequences of reducing physical restraints in the management of the elderly . Can Med Assoc J. 1989;;141:561-564.
19 +
Tinetti ME, Ginter SF.  The Nursing Home Life-Space Diameter: a measure of extent and frequency of mobility among nursing home residents J Am Geriatr Soc. In press.
20 +
SAS Institute Inc.SAS/STAT User's Guide, Release 6.03 Edition . Cary, NC: SAS Institute Inc; 1988;:189-282.
21 +
Tinetti M.  Factors associated with serious injury during falls by ambulatory residents . J Am Geriatr Soc. 1987;;35:644-648.
22 +
Masters R, Favro Marks S.  The use of restraints . Rehabilitation Nurs. 1990;;15:22-25.
23 +
Tinetti ME, Williams TF, Mayewski R.  A fall risk index based on number of chronic disabilities . Am J Med. 1986;;80:429-434.
24 +
Rader J, Doan J, Schwab M.  How to decrease wandering: a form of agenda behavior . Geriatr Nurs. 1985;;6:196-199.
25 +
Rader J.  A comprehensive staff approach to problem wandering . Gerontologist. 1987;;27: 756-760.
26 +
Hussein RA, Brown DC.  Use of two-dimensional grid patterns to limit hazardous ambulation in demented patients . J Gerontol. 1987;;42:558-560.

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