risks to NURSING HOMES residents
Note: The information on this website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
Unnatural deaths in nursing home patients.
Corey TS. et al.
J Forensic Sci, 37(1):222-7 1992 Jan.This article reports on the case of 9 unnatural deaths of nursing home patients, which were attributed to homicide in two individuals and to accidents in the remaining seven. An attempt of concealing the cause of death was discovered in 4 instances. Since nursing home patients suffer from chronic debilitating conditions, their mode of death is often unquestioned by physicians. However, the authors contend that unnatural deaths are significantly underreported in nursing home settings, and urge physicians to investigate cases of sudden unexpected death in these patients in order to exclude any form of abuse they may have been exposed to.
Deaths caused by physical restraints.
Miles SH. et al.
Gerontologist, 32(6):762-6 1992 Dec.This article reports on the case of 122 patients who died because of physical restraint. Eighty-three percent of the victims were living in nursing homes and 78% of them were women. Victims were found suspended from beds and chairs in 58% and 42% of cases, respectively. The authors conclude that restraints are an underreported and preventable cause of death, and are the cause of at least 1 in every 1000 nursing home deaths.
The Last Resort -- The Use of Physical Restraints in Medical Emergencies.
Annas GJ.
N Engl J Med. 1999 Oct 28;341(18):1408-12.This article discusses the law regarding the use of physical and chemical restraint in medicine, and highlights the contribution made by an investigative report conducted by the Hartford Courant, which identified 142 patients who died in psychiatric hospitals while in physical restraints or seclusion during the past decade. The actual number, according to the article, "is probably much higher". The revelations contained in the report helped developing the new federal rules for the use of restraints released in July 1999. Although the new regulations set stricter standards in which restraint can be applied, according to the author of this letter they still don't clarify important issues such as the right of competent patients to refuse treatment and not be forcibly restrained and treated against their will.
Sudden unexplained death in a psychiatric patient
A case report: the role of phenothiazines and physical restraint.
Kumar A.
Med Sci Law, 37(2):170-5 1997 Apr.This article reports on the case of a patient on psychotropic drug treatment who died suddenly while being physically restrained after a violent episode. While there have been several reports of cases of sudden death in association with both psychotropic drug treatment and physical restraint, the author emphasizes the importance of more accurate reporting to determine the true incidence of this complication.
Death by destruction of will. Lest we forget.
Robinson BE.
Arch Intern Med, 155(20):2250-1 1995 Nov 13.
This article reports on the case of a 93-year-old woman who died unexpectedly during resisted mechanical restraint, and reviews the literature supporting the link between resisted restraint and sudden death.
The relationship between physical restraint removal and falls and injuries among nursing home residents.
Capezuti E. et al.
J Gerontol A Biol Sci Med Sci, 53(1):M47-52 1998 Jan.One of the major justifications for use of continuous physical restraint in individuals living in nursing homes is that it prevents them from falling. This study presents evidence demonstrating that this assumption is false and that use of restraints in nursing home residents, on the contrary, is associated with a higher incidence of falls and fall-related injuries. Analysis of the impact of an intervention program aimed at reducing the use of physical restraints revealed that the nursing homes with the least restraint reduction (11% reduction) had a 50% higher incidence of falls and an over two-fold higher incidence of fall-related minor injuries, compared to the nursing homes with 23% and 56% restraint reduction.
Physical restraint use and falls in nursing home residents.
Capezuti E. et al.
J Am Geriatr Soc 1996 Jun;44(6):627-33.The results of this study show that use of physical restraint is associated with an increased risk of falls and recurrent falls in confused, ambulatory nursing home residents.
Deaths caused by bedrails.
Parker K. et al.
J Am Geriatr Soc, 45(7):797-802 1997 Jul.This article reports on the case of 74 deaths caused by bedrails. Three major pattern of death were detected: 70% of the individuals remained trapped between the mattress and the rail with their face pressing against the mattress; 18% remained trapped within the rail with their neck compressed, and 12% of them slid off the bed and had their neck flexed or their chest compressed by the rail. The authors conclude that bedrails are an under-recognized cause of death that could be prevented by more judicious use of these devices in clinical settings.
Restraint reduction reduces serious injuries among nursing home residents.
Neufeld RR, Libow LS, Foley WJ, Dunbar JM, Cohen C, Breuer B.
J Am Geriatr Soc 1999 Oct;47(10):1202-7.The results of this study show that reduction of use of physical restraints among nursing home residents results in a significant decrease in the incidence of serious injuries. After the inception of an educational program, rates of use of physical restraints in a sample of 2075 residents of 16 California nursing homes decreased from 41% to 4%. At the same time, the incidence of moderate to severe injuries declined from 7.5% to 4.4%, a 40% reduction. These data indicate that routine use of restraints in nursing home settings put the physical well-being of residents at risk.
Benzodiazepines and the risk of falls in nursing home residents.
Ray WA, Thapa PB, Gideon P.
J Am Geriatr Soc 2000 Jun;48(6):682-5.The results of this study show that use of benzodiazepines significantly increases the risk of falls in nursing home residents. Overall, use of these drugs was associated with a 44% increased rate of falls. During the first week of use, benzodiapine users had a 3-fold higher rate of falls, compared to nonusers. After the first month of use, rates of falls declined, but were still 30% higher in users versus nonusers.
The use of physical restraints in Western Australian nursing homes.
Retsas A.
Aust J Adv Nurs 1997 Mar-May;14(3):33-9.The results of this study show that, according to a survey conducted on 64 directors of Western Australian nursing homes, 26% of their residents are physically restrained. Ninety-five percent of nursing home directors reported prevention of falls as the reason for use of restraints.
Physical restraints in geriatric care in Sweden: prevalence and patient characteristics.
Karlsson S, Bucht G, Eriksson S, Sandman PO.
J Am Geriatr Soc 1996 Nov;44(11):1348-54.The results of this study show that 24% of 1325 patients from 8 nursing homes, 15 old people's homes, and 2 geriatric clinics in Sweden, are physically restrained. The highest rates of restraints were found among patients from nursing homes and geriatric clinics.
Physical restraints in the practice of medicine. Current concepts.
Marks W.
Arch Intern Med 1992 Nov;152(11):2203-6.This article contends that physical restraints are overused in health care settings. In particular, 85% of nursing home residents will be physically restrained at some point, and so will 17% of hospitalized patients. In spite of widespread use of this practice, no data exist in its support. On the contrary, restraints have been shown to potentially harm the patient, both physically and psychologically.
Mechanical restraints, rehabilitation therapies, and staffing adequacy as risk factors for falls in an elderly hospitalized population.
Arbesman MC, Wright C.
Rehabil Nurs 1999 May-Jun;24(3):122-8.The results of this study, conducted on a sample group of 252 patients aged 60 to 85 years who fell while hospitalized and 250 controls of the same age and length of hospital stay, indicate that those who had been mechanical restrained had a 2-fold higher rate of falls, compared to unrestrained patients. These data support previous studies documenting an increased rate of falls in patients placed in mechanical restraints.
Binding the elderly: a prospective study of the use of mechanical restraints in an acute care hospital.
Robbins LJ, Boyko E, Lane J, Cooper D, Jahnigen DW.
J Am Geriatr Soc 1987 Apr;35(4):290-6.The results of this study show that 17% of elderly patients admitted to an acute care hospital are physically restrained. Restrained patients have a 8-fold increased risk of dying, compared to unrestrained ones, and are significantly more likely to have undergone surgery, intensive medical intervention, or to be mentally impaired, compared to unrestrained ones.
Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors.
Tinetti ME, Liu WL, Marottoli RA, Ginter SF.
JAMA 1991 Jan 23-30;265(4):468-71.The results of this study show that 90% of residents of skilled nursing facilities are placed in mechanical restraints.
Geropsychiatric restraint use.
DeSantis J, Engberg S, Rogers J.
J Am Geriatr Soc 1997 Dec;45(12):1515-8.The results of this study show that 27% of elderly patients admitted to an acute-care psychiatric hospital are placed in mechanical restraints. Unsteady gait and risk of falling were the most common reasons cited for use of restraints.
Reducing the use of physical restraints in nursing homes: will it increase costs?
Phillips CD, Hawes C, Fries BE.
Am J Public Health 1993 Mar;83(3):342-8.The results of this study show that use of physical restraints in nursing home patients increases the costs of their care. Analysis of costs of care for 11,932 residents of 276 U.S. nursing homes revealed that, after controlling for several confounders, restrained patients required significantly more nursing care and nursing-assistant time, compared to similar unrestrained patients. These data indicate that economic reasons cannot be used as a justification for lack of reduction of restraint use among nursing home residents
Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses & prescription of preventive interventions.
Bergstrom N. et al.
J Am Geriatr Soc 1996 Jan;44(1):22-30.This study evaluated the incidence of pressure ulcers in a cohort of 843 patients aged 19 and older who were free from this condition when admitted to two university-operated tertiary care hospitals, two Veteran's Administration Medical Centers (VAMCs), and two skilled nursing homes. Pressure ulcers developed in 8.5%, 7.4% and 23.9% of individuals admitted to tertiary hospitals, VAMCs, and nursing homes, respectively. Use of turning and support surfaces could be implemented to prevent the occurrence of this condition.
Geriatric syndromes as outcome measures of hospital care: can administrative data be used?
Berlowitz DR, et al.
J Am Geriatr Soc 1999 Jun;47(6):692-6.The results of this study, conducted on a cohort of 17,004 individuals discharged from the hospital, show that, upon admission to a nursing home, 12.7% of them had a pressure ulcer, and 43.4% were incontinent. Only 30.8% of individuals with pressure ulcer and 3.4% of those with incontinence had these conditions recorded in the hospital discharge diagnosis. Since these conditions are not accurately reported in the hospital database, they should not be used to assess quality of care among hospitalized patients.
Medication use in residential care facilities for the elderly.
Williams BR, et al.
Ann Pharmacother 1999 Feb;33(2):149-55.The results of this study, conducted on a cohort of 818 residents of residential care facilities for the elderly, show that 94% of them were receiving at least one medication, and, on average, each resident took 5 medications. Many of these drugs were given without a documented diagnosis that justified their use.
Management of pain in elderly patients with cancer. SAGE Study Group
Systematic Assessment of Geriatric Drug Use via Epidemiology.
Bernabei R, et al.
JAMA 1998 Jun 17;279(23):1877-82.This study evaluated pain management in a cohort of 13,625 cancer patients of 65 or more years of age living in nursing homes. Overall, 4,003 patients reported pain. More than a quarter of them, did not receive any pain relief medication. Sixteen percent received a World Health Organization (WHO) level one drug, 32% a WHO level two drug, and only 26% received morphine. Older patients and minority patients were more likely to have their pain untreated.
