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[Restraint in geriatrics: France's backwardness].

Jean-Pierre Jacus1, Marie-Christine Brunet-Jarrige2, Christine-Vanessa Cuervo-Lombard3

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Summary

Passive physical restraint in geriatrics, including bed rails and medication, is common but has harmful effects. Ethical reflection and alternatives are needed to reduce its use and protect elderly patients.

Keywords:
Behavioral disordersChutesContentionEthicsFallsRestraintTroubles du comportementÉthique

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Area of Science:

  • Geriatric Medicine
  • Patient Safety
  • Healthcare Ethics

Background:

  • Passive physical restraint methods in geriatrics have evolved with recommendations and legislation.
  • Practices vary across geriatric settings, with higher prevalence in hospitals compared to nursing homes.
  • Common methods include dual bed barriers, environmental restraints, and medication.

Purpose of the Study:

  • To review the current landscape of passive physical restraint in French geriatric care.
  • To highlight the documented negative effects of restraint use, particularly in preventing falls.
  • To discuss the ethical considerations and potential alternatives to restraint measures.

Main Methods:

  • Review of existing literature and practices in French geriatric facilities.
  • Analysis of the prevalence and types of passive physical restraint employed.
  • Discussion of the consequences and ethical implications of restraint use.

Main Results:

  • Dual bed barriers are the most frequent method, used in both hospitals and nursing homes.
  • Environmental restraints securing facility access are present in 90% of residences for dependent elderly.
  • Passive physical restraint, primarily for fall prevention, has demonstrated deleterious effects, with medication used for behavioral issues.

Conclusions:

  • Passive physical restraint, despite its intentions, carries significant risks and negative outcomes for geriatric patients.
  • Ethical reflection is crucial before implementing any form of restraint.
  • Alternatives, caregiver/family education, and delayed/sequential implementation are proposed strategies to minimize restraint use.