Safety assessment for the frail elderly: a comparison of restrained and unrestrained nursing home residents.
OBJECTIVE
To facilitate clinicians' judgement concerning physical restraint decisions by identifying potentially reversible injury risk factors that differentiate representative samples of restrained and unrestrained nursing home residents.


METHODS
Comparison of restrained and unrestrained nursing home residents on a safety assessment for the frail elderly (SAFE) protocol.


METHODS
Long-term care facilities in the Greater Los Angeles Area.


METHODS
One hundred eight physically restrained and 111 unrestrained nursing home residents.


METHODS
None.


METHODS
(1) Internal, Interrater, and test/retest reliability of the overall SAFE protocol and of the four major factors measured by SAFE; (2) The relationship of SAFE scores to expert judgment of resident injury risk; (3) Differences between large samples of restrained and unrestrained residents on specific SAFE score factors.


RESULTS
Two walking, one transition, and one judgment factor are reliably measured by the SAFE protocol. SAFE scores were significantly correlated with expert judgment of risk for injury and showed large differences between restrained and unrestrained residents, even after differences in ambulation ability between the two groups were accounted for.


CONCLUSIONS
The SAFE is a reliable protocol that measures behavioral factors related to falls and risk for injury among nursing home residents with a broad range of cognitive impairment. Factors that significantly differentiate restrained and unrestrained groups should be targeted for rehabilitation and remediation in physical restraint reduction efforts. Removing or changing restraints for the large sample (50%) of restrained residents who were not ambulatory will not significantly increase their mobility, since the majority of this group could not independently propel their wheelchairs. Increased mobility for the large group of both restrained and unrestrained residents will likely be realized only if restraint reduction programs are combined with interventions to improve both mobility and the specific behavioral performance factors measured by SAFE.
Schnelle
J F
JF
Borun Center for Gerontological Research, UCLA School of Medicine.
Mac Rae
P G
PG
Simmons
S F
SF
Uman
G
G
Ouslander
J G
JG
Rosenquist
L L
LL
Chang
B
B
D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D016330:Frail Elderly; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D007902:Length of Stay; D015141:Los Angeles; D009735:Nursing Homes; D012149:Restraint, Physical; D012307:Risk Factors; D012449:Safety; D016138:Walking; D014910:Wheelchairs; D014947:Wounds and Injuries / Q000517:prevention & control*