Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study.
OBJECTIVE
This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments.


METHODS
Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries.


RESULTS
The prevalence of physical restraint use varied more than five-fold across the study countries, from an average 6% in Switzerland, 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada. The prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26-27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed across facilities in both physical restraint and antipsychotic use rates. In all countries, neither facility case mix nor organizational characteristics were particularly predictive of the prevalence of either treatment.


CONCLUSIONS
There exists large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries. Since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the idiosyncratic factors specific to each country that contribute to variation in use rates.
Feng
Zhanlian
Z
Center for Gerontology & Health Care Research, The Warren Alpert Medical School, Brown University, Providence, RI 02903, USA. Zhanlian_Feng@brown.edu
Hirdes
John P
JP
Smith
Trevor F
TF
Finne-Soveri
Harriet
H
Chi
Iris
I
Du Pasquier
Jean-Noel
JN
Gilgen
Ruedi
R
Ikegami
Naoki
N
Mor
Vincent
V
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002170:Canada; D002681:China; D003430:Cross-Sectional Studies; D005387:Finland; D006723:Hong Kong; D006801:Humans; D008134:Long-Term Care / Q000592:standards; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000458:organization & administration*; D015995:Prevalence; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D013557:Switzerland; D014481:United States
D014150:Antipsychotic Agents