The prevention and reduction of physical restraint use in long-term care

Abstract

In the year 1999, the appeal to reduce the use of physical restraints in persons with dementia living in institutionalized long-term care settings was sharply criticized by nursing home staff in the Netherlands. At that time, it was argued that the use of physical restraints such as waist belts and two-sided full-enclosed bedrails was needed to provide safe care in residents suffering from cognitive impairment, such as dementia. Physicians and nurses demonstrated, showing individual cases of residents with severe injuries after falls, that the use of restrictive physical restraints in nursing homes was legitimate. How different is this in 2017? Nowadays, the large majority of nursing home staff does not assess the use of belts and other restrictive physical restraints as adequate anymore. Like in many countries, in the Netherlands, the use of physical restraints is an indicator of poor quality of care in institutionalized long-term care settings now. This is the result of more than 15 years of scientific research and dissemination and implementation of research results in clinical practice and healthcare policy. In this chapter, an overview of this research process conducted in the Living Lab in Ageing and Long-Term Care (Verbeek et al. 2013) will be presented. The Living Lab is a structural collaboration between Maastricht University, Zuyd University of applied sciences and long-term care organizations providing care for persons with dementia. Knowing that many older persons suffering from cognitive impairment do not have a formal diagnosis of dementia, this chapter focuses on persons with cognitive impairment in general and dementia in particular. After a description of physical restraints in institutionalized long-term care, its prevalence, determinants, and consequences, we will describe the effects of an approach named EXBELT, aiming at the prevention and reduction of physical restraints in persons with dementia living in institutionalized long-term care settings. This chapter will be concluded with the use of physical restraints in persons with cognitive impairment living in the community, as aging in place is highly on the agenda in many countries.