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Restraints Don't Prevent Falls

Falls in hospitals and nursing home are an everyday occurrence. In many instances, elders (especially if they are confused or have memory problems) have a tendency to forget they're not able to walk or get out of bed by themselves and, as a result, fall while trying to. In years past, the use of physical restraints (straight jackets, belts, vests, etc.) were utilized to protect elders from falling and injuring themselves.

Since then, awareness has grown about the negative effects restraints produce:
  • Bruising of the skin
  • Breathing difficulties
  • Loss of muscle strength and balance
  • Increased agitation, depression, anxiety, fear, and helplessness
  • Injuries (including strangulation) resulting from the person trying to escape from the restraint.

But the biggest negative! Restraints don’t prevent falls! In reality, they are frequently ineffective in protecting elders.

Thankfully, due to federal law and regulations, the days of straight jackets and vests are a thing of the past. But unfortunately, the practice of ‘restraining’ elders to prevent falling is still all too common in many of our healthcare institutions.

Elders who are at greatest risk for restraints include those with:
  • Mobility problems (difficulties with walking /balance)
  • Cognitive problems (dementia)
  • Behavioral disturbances (agitation and other outbursts)
  • History of multiple falls

If you’re a family caregiver and your loved one is:
  • At risk of falling (or has fallen repeatedly) and has mobility and memory problems.
  • Residing in a healthcare facility (including hospitals, nursing homes, assisted living facilities, home care, etc)

You need to be aware of:
  • What types of ‘restraint practices’ staff may be utilizing on a routine basis
  • What some of the alternatives to restraint are

Types of Restraint

A restraint is anything (including devices, drugs or people) that gets in the way of an elder’s movement or restricts their freedom. Common examples of restraint practices that may not look like typical restraints but are, include:

Seat Belts/Lap Cushions
  • Seat belts and lap cushions are used in wheelchairs to protect someone from falling out of the chair or from getting up without assistance. Devices that the person can’t remove are considered a restraint and pose a danger. If the person tries to get out of the chair, they may fall forward with the wheelchair still attached.

Recliner Chairs
  • Recliner chairs provide persons with comfort and good sitting posture. But the chair is also a restraint for those unable to get out of the chair by themselves.

Bed Side Rails
  • Beds (hospital type beds) are equipped with side rails. These are used to prevent a person from rolling or falling out of his bed. Sometimes, however, side rails are used to keep someone from getting out of the bed, thus making the side rail a restraint. This can be very dangerous. People can become entrapped in them or injured while trying to go over top of the rails. 

Tucking in Sheets Tightly
  • Tucking in bed sheets too tightly (or using Velcro hook/loop fasteners) so that the person can't get out of bed by themselves or move about freely; this is a restraint.

Tables and Seat Trays
  • Pushing someone in a wheelchair up to a table and locking the chair in position can also be a restraint since it prevents the person from moving about freely. This can be quite dangerous as a person may push backwards and tip the wheelchair (and themselves) over. Likewise, placing a locking seat tray in front of someone, is considered a restraint if it inhibits the person's ability to get up.

  • Many persons with dementia, behavioral issues and fall risk are treated with sedatives and anti-psychotic drugs to control their behavior and risk of falling; often these drugs have dangerous side effects and act more like ‘chemical restraints’.

Nurses (and staff)
  • Sometimes if person who is at fall risk and is getting up from bed or a chair, a nurse will yell at the person “To sit back down and not get up”. If the nurse does not follow up with finding out why the person is getting up and/or not assisting them with their needs, then this action represents a restraint.

  • Older eyes respond more slowly to the glaring lights of institutions and may perceive the shiny, well-buffed floors as slippery, causing many elders to stay put and not move about; another form of restraint.

Alternatives to Restraints

Sometimes, family caregivers, who are concerned about the safety of their loved one, will insist on the use of a restraint to avoid falls. Much of this is due to ignorance of the negative consequences of restraints and/or alternatives to it. Family caregiver need to champion non-restraint use in their loved ones if they see ‘restraint’ being used. Nurse convenience or lack of available staff should never be accepted as a need for restraints. Sometimes a person’s medical condition requires ‘restraint’ to prevent injury. However, this decision should be rare, short term and done with extreme caution. Any frequent or continued use of restraint needs to be questioned. Healthcare facilities are required to continually explore and utilize alternatives to restraint. Examples of interventions that help to reduce the use of restraint include:

Personal Care
  • Prevent predisposing and precipitating factors for falls and poor mobility...
  • Prevent cognitive impairment.
  • Assist persons with meeting their daily needs (nutrition, hydration, pain relief, routine toileting, etc.).
  • Eliminate unnecessary medication.
  • Provide balance and gait training, and strengthening exercises.

Supportive Safety Equipment
  • Low beds/mat placed on the floor (to avoid injurious falls).
  • Bed/chair alarms (used to alert staff that a person has left their bed/chair by themselves when they shouldn’t have).
  • Family/sitters (family caregivers/nurses watch persons 24/7 when at high fall risk).
  • Hip protectors (shock-absorbing pads worn to prevent hip fractures).
  • Nonslip floor/footwear.
  • Walking aids (canes/walkers to support safe walking/balance).

Guest post by Dr. Rein, this post originally appeared in E-CareDiary.com

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting.

Dr. Rein has written several online continuing education course on falls: 

Caring for People With Fall Risks
Facts About Falls
Managing Falls In the Nursing Home: Who, Why and What Next?
Managing Falls IN the Nursing Home for Administrators
Preventing Falls
The Fall Prevention Care Process

Dr. Lisa Goins has written a fall prevention course:

Vitamin D Prevent Falls in Older Adults 

Posted: 4/13/2015 4:13:19 PM
Hi Jean-
We provide ALL of our education through online courses. To view our entire catalog, see this link:http://www.pedagogyeducation.com/Main-Campus/Class-Catalog/View-Entire-Catalog.aspx
8/31/2015 11:53:31 AM

Jean chipman
Would like to get more info and any classes to attend in California
8/30/2015 7:52:54 PM

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