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Avoidance of Physical Restraint Use among Hospitalized Older Adults: A Review of Clinical Effectiveness and Guidelines

Last updated: February 28, 2019
Project Number: RC1079-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness regarding the use of physical restraints among hospitalized older adults?
  2. What is the clinical effectiveness regarding the avoidance of physical restraints among hospitalized older adults?
  3. What are the evidence-based guidelines regarding the use or avoidance of physical restraint among hospitalized older adults?

Key Message

One relevant systematic review was identified on the use of physical restraints, specifically the use of bed rails for preventing falls, among hospitalized older adults. This review did not uncover any relevant studies; thus, no conclusions regarding the use of restraints can be provided.Evidence of limited quality from two clinical studies on the avoidance of physical restraints among hospitalized older adults suggested that reducing restraint use may shorten average length of stay, especially for older patients who are cognitively impaired. Programs aimed to reduce physical restraint use improved mobility and activities of daily living outcomes, but did not significantly affect fall or mortality rates. One Canadian evidence-based guideline was identified, which recommends using principles of least restraint/restraint as a last resort when caring for older adults.Given the limited availability and low quality of evidence, the effectiveness and use of physical restraints among hospitalized older adults remains uncertain, but reduced restraint use seems to be preferred.