Use of physical restraints in the elderly in an Emergency Department

BACKGROUND AND OBJECTIVE. The use of physical restraints in the elderly in Spanish hospitals has rarely been studied, especially the use in emergency departments (EDs). This study aimed to describe the use of restraint in a hospital ED.
MATERIAL AND METHODS. Prospective observational study of elderly patients under physical restraint in the ED of Hospital Universitario Severo Ochoa in Leganés in the autonomous community of Madrid. We observed and selected patients over the age of 65 years in physical restraints. Data on functional and cognitive status were extracted from the patients’ charts and recorded while interviewing family and staff.
RESULTS. Restraints were used on 1.84% of those over the age of 65 years, and we analyzed data for 93 of these restrained patients. The mean age was 83 years, and 59.14% were men with a high degree of functional dependency. A history of delirium was present in 38.71%, and 34.4% had been restrained during previous hospital admissions. The most common reason for using restraints was to protect therapeutic devices (37.63%), but there was no clear indication recorded in 31.18% of the cases of restraint use. Tolerance was poor in 58% of restrained patients, and the use of sedatives increased after restraint in 67.74%. Younger patients among the elderly were restrained at 3 or more points more often (P < .05). Failure to record the order for restraint occurred more often in patients who had dementia or were older (P < .05).
CONCLUSIONS. Elderly patients are often physically restrained. Use of restraints sometimes does not follow recommendations and is under-recorded in patient charts. The inappropriate, undocumented use of restraints occurs more often in elderly patients of more advanced age and those with established cognitive deficit.