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Why do we use physical restraints in the elderly?

Warum fixieren wir ältere Menschen?

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Summary

The use of physical restraints in the elderly is a common practice in many countries. This paper summarizes the current knowledge on the use of restraints in home care, hospitals and nursing homes. Between 1999–2004 the reported prevalence numbers range from 41–64% in nursing homes and 33–68% in hospitals; numbers of restraint use in home care are unknown. Bed rails and belts have been reported as the most frequently used restraints in bed; chairs with a table and belts are the most frequently reported restraints in a chair. It is evident that physical restraints in most cases are used as safety measures; the main reason is the prevention of falls. In the hospital setting, the safe use of medical devices is also an important reason for restraint use. Predictors for the use of physical restraints are poor mobility, impaired cognitive status and high dependency of the elderly patient and the risk of falls in the nurses’ opinion. Furthermore, there are indications that restraint use is related to organizational characteristics. Finally, many adverse effects of restraint use have been reported in the literature, like falls, pressure sores, depression, aggression, and death. Because of the adverse effects of restraints and the growing evidence that physical restraints are no adequate measure for the prevention of falls, measures for the reduction of physical restraints are discussed and recommendations are made for future research.

Zusammenfassung

Die Anwendung von Fixierung ist in vielen Länder üblich. Dieser Artikel fasst unsere Kenntnis über die Anwendung von Fixierung in der häuslichen Pflege im Krankenhaus und im Pflegeheim zusammen. Zwischen 1999–2004 betrug die gemeldete Prävalenz 41–64% in Pflegeheimen und 33–68% in Krankenhäusern; die Prävalenz in der häuslichen Pflege ist unbekannt. Bettgitter und Fixierungsgurte werden am meisten angewendet im Bett; Stühle mit einem Brett und Fixierungsgurte werden am meisten angewendet im Stuhl. Es ist evident, dass eine Fixierung meistens als Sicherheitsmaßname angewendet wird; der Hauptgrund ist die Prävention von Stürzen. Die sichere Anwendung von medizinischen Interventionen ist ein wichtiger Grund zum Gebrauch der Fixierung im Krankenhaus. Eingeschränkte Mobilität, Verringerung der kognitiven Funktion, große Hilfsbedürftigkeit des älteren Patienten, und das Sturzrisiko nach der Meinung des Plegepersonals, sind Faktoren die die Anwendung von Fixierung voraussagen. Daneben gibt es Hinweise dass die Anwendung von Fixierung zusammenhängt mit organisatorischen Abläufen. Schließlich sind viele negative Konsequenzen von Fixierungsmaßnahmen in der wissenschaftlichen Literatur beschrieben wie Stürze, Dekubitus, Depressionen, Agression und Tod. Wegen dieser negativen Konsequenzen und dem verstärkten Beweis, dass eine Fixierung keine angemesse Intervention ist für die Prävention von Stürzen, werden Maßnamen zur Reduzierung von Fixierung besprochen und Empfehlungen gemacht für zukünftige Forschung.

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  1. Universiteit Maastricht, Department of Health Care Studies, Section of Nursing Science, 616, 6200, MD Maastricht, The Netherlands

    J. P. H. Hamers &  A. R. Huizing

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  1. J. P. H. Hamers
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Correspondence to J. P. H. Hamers.

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Hamers, J.P.H., Huizing, A.R. Why do we use physical restraints in the elderly?. Z Gerontol Geriatr 38, 19–25 (2005). https://doi.org/10.1007/s00391-005-0286-x

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