[Physical restraint in old people's homes. Evaluation of skills following specific training]

The use of physical restraint in elderly patients is sometimes necessary but not without risk. We studied the prevalence and modalities of physical restraint in elderly patients in 6 old people's homes in the urban area of Toulouse, and emphasized the need for better use by the nursing staff of physical restraint in such patients with a specific training course.

Other than the prevalence of restraint, we also examined the modalities of its use in elderly patients. We studied the respect of the Anaes (Agence nationale d'accréditation et d'évaluation en santé) guidelines regarding the use of restraint in such patients, before and after an intervention that associated first a collective training course of all the staff in the old people's homes, and then specific individual training by a visiting practitioner. The information concerning the number of patients in whom restraint was used was obtained from the manager of the home or from the head nurse and was then checked by the investigator.

The prevalence of restraint was of 22.2% (n=110 patients) at the start of the study, 15.9% following training sessions (at 6 months) and 15.5% at the end of the study (at 9 months). Skills improved regarding the benefit/risk assessment, the installation of the person restrained and the regular removal of the restraint during the day.

Our strategy helped to underline this problem for the staff. The Anaes guidelines are too strict to be applied in old people's homes. One of the key points in improved management would be the presence of a coordinating physician and nurse in all the institutions caring for the elderly.