The Prevalence and Risk Factors of Physical Restraint Among Patients Under Palliative Care in Taiwan

Background: Physical restraint for patients approaching their end of life may induce distress and impair dignity. Limited studies have been reported on the frequency and factors influencing restraint application during terminal phases of patients in hospital settings. Objective: We aimed to study the occurrence and factors that predict utilization of physical restraints in hospitalized terminally-ill adults. Setting/Subjects: We collected data from a single regional hospital in central Taiwan. All terminally ill patients admitted to the palliative care unit (PCU) from January 2019 to September 2023 were enrolled. Measurements: Physical restraint was defined as being physically restrained during hospitalization for >8 hours under medical order. We retrospectively identified potential risk factors for restraint use from a number of variables, including the type of primary diagnosis, medications used including benzodiazepine (BZD) and strong opioid, procedures involving nasogastric (NG) tube, Foley insertion, reason of discharge, and the specialty of attending physician. Multivariate logistic regression was used to analyze the risk factors predicting the use of physical restraint. Results: From 2019 to 2023, 688 patients with an average age of 82.1 years (standard deviation: 13.1) were included for the final analysis. Of them, 69% were male, and 9.5% received physical restraint during hospitalization. After adjusting for multiple confounding factors, the use of BZD (odds ratio [OR]: 2.34, 95% confidence interval [CI]: 1.32-4.15) and NG tube (OR: 2.53, 95% CI: 1.38-4.65) were identified as significant risk factors predicting the application of physical restraint. Subgroup analyses showed that female gender with cancer (OR: 5.43, 95% CI: 1.01-29.05) was another significant risk factor, apart from the use of BZD and NG tube. Conclusions: This is the first study on risk factors predicting the use of physical restraint in a palliative care setting. Palliative care professionals should carefully deliberate the use of BZD and NG tubes among terminally ill patients in PCU.