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Physical restraint use and cognitive decline among nursing home residents
L C Burton1, P S German, B W Rovner
1Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.
Objective:
This study investigated the association between physical restraint use and decline in cognition.
Design:
Cohort analytic study describing changes in resident characteristics.
Setting:
Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area.
Participants:
437 nursing home admissions, with 201 remaining at 1 year.
Main Outcome Measures:
Cognitive status was measured by geropsychiatrists, using the Folstein Mini-Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year.
Results:
Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non-ambulatory but without dementia and having strong social support.
Conclusions:
These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.