The practice of containment in the elderly: an integrative review

Integrative literature review, searching for primary studies published from 2013 to 2017, conducted in the electronic databases of LILACS and MEDLINE, in the months of May and June of 2018. The searches were obtained by crossing the descriptors and words: containment; restriction; physical restraint; and elderly.

Results

A total of 17 articles were included, and the analysis indicated that the available evidence in the literature reports to the practice of restraints in the daily life of the elderly, the consequences for use of restraints in the elderly, and alternative techniques to the use of restraints.

Conclusion

The use of restraints, mainly physical and chemical, is permeated by a higher probability of cognitive decline of the elderly, as well as physical and psychological health consequences, and can even result in death. Intervention programs and policies designed to reduce the use of restraints in the elderly are shown as alternative strategies, contributing to the qualification of care.

Aged; Restraint physical; Geriatric nursing; Nursing care; Health of the elderly

Nº	Type of contention	Level of evidence	Main evidence
Bleijlevens et al.⁽⁸⁾	Mechanical	N6*	Proposes an educational program to reduce the forms of containment in Dutch nursing homes.
Enns et al.⁽⁹⁾	Physical	N2*	Highlights the implementation of strategy to reduce the use of physical containment in the elderly
Fariña-López et al.⁽¹⁰⁾	Physical	N4**	From a professional perspective, most did not agree with the signature of the terms of consent for containment of the elderly.
Foebel et al.⁽¹¹⁾	Physical and pharmacological /chemical	N2***	Chemical containment (use of antipsychotic medications) was higher than the use of physical restraint.
Gagnon et al.⁽¹²⁾	Mechanical and environmental	N2**	Listening and communication was evidenced, as alternatives to containment.
Goethals et al.⁽¹³⁾	Physical	N2**	The practice of restraint in the elderly is based on the decision-making processes of the nurse
Gulpers et al.⁽¹⁴⁾	Mechanical	N6*	An intervention program for decreasing the use of restraints may change attitudes towards reduction of its use.
Hofman et al.⁽¹⁵⁾	Physical	N4***	The rate of restraint use in elder care settings varies, depending on the scenario and type of containment involved. The use of physical restraints can be one of the most prevalent in the nursing homes.
Huang et al.⁽¹⁶⁾	Physical	N4***	The main reasons for use of restraint included to prevent the removal of devices (enteric, orotracheal, and vesical tubes and tracheostomies, among others)
Konetzka et al.⁽¹⁷⁾	Physical and pharmacological /chemical	N4***	United States implemented the addition of rates of antipsychotic use to the reports of long-stay institutions for the elderly, in order to match the transparency of physical and pharmacological / chemical restraint.
Kurata et al.⁽¹⁸⁾	Physical	N4***	The knowledge and perception of physical restraints used in the elderly living in the home differs between familiar caregivers and professional caregivers in home care.
Øye et al.⁽¹⁹⁾	Physical	N4***	Residence time, degree of dependence, limitation of mobility, and some organizational characteristics can be associated with restraint use
Bellenger et al.⁽²⁰⁾	Physical	N2***	The practice of containment can result in death, as a consequence of mechanical asphyxia, and the main justification for containment is the prevention of falls.
Kong et al.⁽²¹⁾	Physical	N2*	The containment reduction program has effectively improved the team’s perceptions and attitudes about the use of restraints in the elderly
Muñiz et al.⁽²²⁾	Physical	N2*	Physical restraints can be almost completely eliminated while maintaining reasonable levels of safety.
Gjerberg et al.⁽²³⁾	Physical	N2**	Relatives of the elderly accept the use of restraint, because they believe that the health team always acts in the best interest of the patient.
Scheepmans et al.⁽²⁴⁾	Mechanical	N4***	The use of mechanical containment in the elderly is justified by the guarantee of safety.

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[1] Corresponding author. Carolina Backes https://orcid.org/0000-0002-2504-9105 E-mail: karolbackes@hotmail.com