Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial.
BACKGROUND
The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting.


OBJECTIVE
The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospitalized adults.


METHODS
Secondary analysis was performed on data from the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial conducted between 2005 and 2011. Medical record data were abstracted from six Veterans Administration Medical Centers (VAMCs). Data on processes of care in the last seven days of life were abstracted from the medical records of 5476 who died in the six VAMCs. We prospectively identified potential risk factors for restraint use at the time of death from among the variables measured in the parent trial, including location of death, medications administered, nasogastric tube, intravenous (IV) fluids, family presence, and receipt of a palliative care consultation.


RESULTS
Physical restraint use at time of death was documented in 890 decedents (16.3%). Restraint use varied by location of death, with patients in intensive settings being at higher risk. Restraint use was significantly more likely in patients with a nasogastric tube and those receiving IV fluids, benzodiazepines, or antipsychotics.


CONCLUSIONS
This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities.
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|2Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.
Elizabeth
E
Kvale
3School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
J Nicholas
JN
Dionne-Odom
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|4Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
David T
DT
Redden
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|2Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.
F Amos
FA
Bailey
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|3School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
Marie
M
Bakitas
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|2Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.
Patricia S
PS
Goode
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|2Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.
Beverly R
BR
Williams
5William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina.
Kathlyn Sue
KS
Haddock
1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama.|2Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.
Kathryn L
KL
Burgio
D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012307:Risk Factors; D013727:Terminal Care; D014481:United States; D014728:Veterans