Physical restraint use and cognitive decline among nursing home residents.
OBJECTIVE
This study investigated the association between physical restraint use and decline in cognition.


METHODS
Cohort analytic study describing changes in resident characteristics.


METHODS
Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area.


METHODS
437 nursing home admissions, with 201 remaining at 1 year.


METHODS
Cognitive status was measured by geropsychiatrists, using the Folstein Mini-Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year.


RESULTS
Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non-ambulatory but without dementia and having strong social support.


CONCLUSIONS
These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.
L C
LC
Burton
P S
PS
German
B W
BW
Rovner
L J
LJ
Brant
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D005852:Geriatric Psychiatry; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008609:Mental Status Schedule; D009735:Nursing Homes; D015995:Prevalence; D044469:Racial Groups; D012149:Restraint, Physical; D012944:Social Support
D014150:Antipsychotic Agents