Contención Mecánica en Hogares para Ancianos: studio transversal

estudio transversal, realizado en 14 instituciones, con una muestra final de 443 personas mayores. La ocurrencia de contención mecánica se consideró como una variable dependiente.

Resultados:

hubo una prevalencia del 7,45% para la contención mecánica considerando las barandas de la cama y el 3,84% sin considerar las barandas de la cama. La principal justificación para usar la restricción fue el riesgo de caídas (66.7%), y la duración de la restricción fue de 24 horas (84.8%). Los factores asociados con la variable dependiente fueron: caminar (p = 0.000); MEEM, con pérdida cognitiva (p=0.000); Índice de Katz, con dependencia para las actividades de la vida diaria (p=0.000); y comorbilidad de Alzheimer (p=0.001).

Conclusión:

la prevalencia fue menor que los estudios internacionales, pero hubo una asociación con el empeoramiento de la marcha, la dependencia, el empeoramiento cognitivo y la enfermedad de Alzheimer, lo que demuestra la necesidad de intervenciones alternativas a la restricción mecánica.

Descriptores:
Hogares para Ancianos; Restricción Física; Anciano; Enfermería Geriátrica; Salud del Anciano

Institution	Total elderly	Elderly people restrained, without considering bed rail	Elderly people restrained General	Restraint prevalence, without considering bed rail	Restraint prevalence General
NH 01	39	1	1	2.56	2.56
NH 02	36	0	1	0.00	2.78
NH 03	33	1	1	3.03	3.03
NH 04	27	0	1	0.00	3.70
NH 05	24	0	1	0.00	4.17
NH 06	46	0	2	0.00	4.35
NH 07	60	3	3	5.00	5.00
NH 08	9	1	1	11.11	11.11
NH 09	44	4	5	9.09	11.36
NH 10	50	1	6	2.00	12.00
NH 11	16	0	2	0.00	12.50
NH 12	24	3	3	12.50	12.50
NH 13	18	0	3	0.00	16.67
NH 14	17	3	3	17.65	17.65
Global	443	17	33	3.84	7.45

Restraint characteristics	f	%
Restraint place
Wheelchair	9	27.3
Plastic chair	6	18.2
Wooden bed	1	3.0
Hospital bed	15	45.5
Sofa	2	6.1
Restraint type
Bandage	1	3.0
Bed rail	15	45.5
Adapted wooden rail	1	3.0
Sheeting	16	48.5
Justification for restraint
Risk of falls	22	66.7
Agitation, aggressiveness, and wandering	6	21.2
Institutional protocol	3	9.1
Risk of falls and medical request	1	3.0
Restraint duration
4 hours a day	1	3.0
12 hours a day	4	12.1
24 hours a day	28	84.8

Variables	Statistics						p value
Variables	n	%	n	%	n	%	p value
Sex	Female		Male		Global
Not restrained	24	72.7	9	27.3	33	100.0
Restrained	27	81.8	6	18.2	33	100.0	0.418^† † Chi-square test (χ2);
	With
Wandering	No		Assistance		Yes
Not restrained	8	24.2	3	9.1	22	66.7	0.000^† † Chi-square test (χ2);
Restrained	24	72.7	2	6.1	7	21.2
Immobility Syndrome	Yes		No		Total
Not restrained	25	46.3	29	53.7	54	100.0	0.202^† † Chi-square test (χ2);
Restrained	8	66.7	4	33.3	12	100.0
Age	Mean		SD		CV ^ CV – coefficient of variation;
Not restrained	79.8		10.1		0.13		0.083^¥ ¥ Mann-Whitney test;
Restrained	83.8		7.8		0.09
Institutionalization time	Mean		SD^* * SD - Standard Deviation;		CV^ CV – coefficient of variation;
Not restrained	4.30		4.1		0.96		0.598^¥ ¥ Mann-Whitney test;
Restrained	4.85		4.1		0.84
Number of medications	Mean		SD^* * SD - Standard Deviation;		CV^ CV – coefficient of variation;
Not restrained	5.8		4.0		0.70		0.773^δ δ Student’s t-test.
Restrained	6.1		3.6		0.59
Number of psychotropic drugs	Mean		SD^* * SD - Standard Deviation;		CV^ CV – coefficient of variation;
Not restrained	1.4		1.2		0.90		0.140^¥ ¥ Mann-Whitney test;
Restrained	1.9		1.3		0.70
Katz Index	Mean		SD^* * SD - Standard Deviation;		CV^ CV – coefficient of variation;
Not restrained	4.1		2.1		0.50		0.000^¥ ¥ Mann-Whitney test;
Restrained	0.5		1.0		2.21
MMSE	Mean		SD^* * SD - Standard Deviation;		CV^ CV – coefficient of variation;
Not restrained	15.6		9.6		0.61		0.000^¥ ¥ Mann-Whitney test;
Restrained	3.3		5.5		1.66

Comorbidity	Not restrained		Restrained		P value of chi-square test	OR	OR CI
Comorbidity	F	(%)	F	(%)	P value of chi-square test	OR	OR CI
Alzheimer’s Disease	2	6.1	14	42.4	0.001	11.4	2.3 - 55.8
Heart disease	8	24.2	2	6.1	0.032	0.2	0.04 - 1.04
Hypertension	27	81.8	19	57.6	0.032	0.3	0.098 - 0.926
Diabetes Mellitus	13	39.4	7	21.2	0.108	0.41	0.14 - 1.23
Femoral fracture	3	9.1	0	0.0	0.230^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Osteoporosis	6	18.2	2	6.1	0.258^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	0.29	0.05 - 1.56
Arthritis	2	6.1	0	0.0	0.492^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Parkinson’s Disease	2	6.1	0	0.0	0.492*	nc	nc
Ulcer caused by friction	1	3.0	3	9.1	0.613^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	3.2	0.32 - 32.5
Stroke	3	9.1	5	15.2	0.708^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	1.8	0.39 - 8.17
Gastritis	7	21.2	6	18.2	0.757	0.82	0.25 - 2.79
Cataract	3	9.1	2	6.1	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	0.65	0.10 - 4.14
Chronic Obstructive Lung Disease	2	6.1	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	0.48	0.04 - 5.62
Glaucoma	0	0.0	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Amaurosis	1	3.0	0	0.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Seizure	0	0.0	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Neurodegenerative dementia	0	0.0	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Depression	1	3.0	0	0.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Senile dementia	1	3.0	2	6.1	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Schizophrenia	1	3.0	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	1.00	0.06 - 16.7
Gatrostomy	0	0.0	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc
Hypothyroidism	3	9.1	3	9.1	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	1.00	0.19 - 5.36
Venous Insufficiency	2	6.1	1	3.0	1.000^* * Fisher’s exact test; nc - not calculable due to the null frequency in one of the groups.	nc	nc

Group	Ulcer stage	Ulcer region	Restraint type	Restraint place	Restraint time
Not restrained	II	Sacrococcygeal	-	-	-
Restrained	IV	Sacrococcygeal	Sheeting	Wheelchair	12
	I	Calcaneus	Bandage	Wheelchair/hospital bed with railing	4/20
	II	Calcaneus and Sacrococcygeal	Sheeting	Wheelchair	24
	I	Right arm and Left leg	Hospital rail bed	Hospital bed	24
	I	Right knee	Hospital rail bed	Hospital bed	24
	II	Malleolus D

Institution	Number of Beds	Nurse	Nurs. Tech.	Nurs.Ass.	Caregiver	Total Employees	Restrained
NH 07	60	1	10	0	13	24	3
NH 14	17	1	2	0	2	5	3
NH 04	27	1	7	0	0	8	1
NH 08	9	1	0	0	5	6	1
NH 11	16	1	3	0	3	7	2
NH 13	18	1	5	0	4	10	3
NH 06	46	1	12	0	8	21	2
NH 05	24	1	4	0	2	7	1
NH 01	40	1	5	0	4	10	1
NH 10	50	3	2	2	4	11	6
NH 12	24	3	6	0	3	12	3
NH 09	44	1	6	0	0	7	5
NH 03	33	0	3	0	6	9	1
NH 02	36	3	11	0	0	14	1

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Romulo DelValle E-mail:delvalleromulo@gmail.com