Physical restraint in elderly in home care: a cross-sectional study

This was a cross-sectional study with 162 elderly randomly assigned to a home care program in Rio de Janeiro, from March 2018 to July 2018. Used as a technique for data collection and direct observation and structured interview of elderly clinical data. Data were analyzed descriptively and inferentially.

Results

There was a 13% prevalence of mechanical restraint in elderly in home care. The most frequent restraints were the use of bandage, tissues and sheets in the arms/legs and chests of the elderly, and the justification for their use were control of aggressive behavior (28.6%), prevention of falls (19%) and protection (19%). Of the total elderly participants, 42.9% remained contained for more than 24 hours, and in 85.7% of the cases, the individuals were confined to a room.

Conclusion

It is necessary to expand the training of formal and informal caregivers, recommending the rehabilitation of care practices that preserve the elderly's autonomy, giving them dignity, respecting gerontological and home care principles.

Keywords
Restraint; physical. House calls. Home health nursing. Geriatric nursing. Health of the elderly

Characteristics of the restraint	Sample
Characteristics of the restraint	n	%
Type of Mechanical Restraint
Bandage	08	38.1
Tissue	05	23.8
Sheet	05	23.8
Rail	03	14.3
Justification for restraint
Aggressiveness	06	28.6
Agitation	04	19.0
Risk of falls	06	28.6
Lack of caregivers	01	4.8
Family order	01	4.8
Duration of restraint
8 hours a day (morning)	01	4.8
8 hours a day (night)	04	19.0
22 hours a day (No restraint during lunch)	01	4.8
22 hours a day (No restraint during bath)	06	28.6
24 hours a day	09	42.9

Variable	Unrestrained		Restrained		Global		p-value
Variable	F	%	f	%	f	%	p-value
Gender
Female	85	60.3	13	61.9	98	60.5	0.887
Male	56	39.7	8	38.1	64	37.6
Age
60-68 years	36	25.5	05	23.9	41	25.4	0.276^(a)
69-76 years	54	38.3	07	33.3	61	37.6
77-84 years	40	28.4	07	33.3	47	29.0
85-91 years	11	7.8	02	9.5	13	8.0
Caregiver
Family member	96	68.1	10	47.6	106	65.4	0.066
Formal Caregiver	27	19.1	07	33.3	34	21.0	0.154^(b)
Nursing Technician	11	7.8	04	19.0	15	9.3	0.109^(b)
Nursing Assistant	18	12.8	05	23.8	23	14.2	0.185^(b)
Care Routine
Morning	24	17.0	09	28.6	30	18.5	0.229(b)
Afternoon	09	6.4	01	4.8	10	6.2	1.000(b)
Night	13	9.2	03	14.3	16	9.9	0.468
On alternate Days	02	1.4	05	23.8	07	4.3	0.000
Every day	95	67.4	10	47.6	105	64.8	0.077
Duration of Integrated Home Care Service (SIAD)
01 year	42	29.8	06	28.6	48	29.6	0.398^(a)
02 years	42	29.8	04	19.0	46	28.4
03 years	15	10.6	03	14.3	18	11.1
04 years	14	9.9	02	9.5	16	9.9
05 years	18	12.8	02	9.5	20	12.3
06 years	04	2.8	03	14.3	07	4.3
07 years	06	4.3	01	4.8	07	4.3

Group	Site of Injury	Type of Restraint	Duration of restraint of elderly patients	Number of Cases
Unrestrained	Calcaneus	-	-	05
	Knee	-	-	01
	Occipital bone	-	-	01
	Sacrum	-	-	04
	Trochanter	-	-	01
Restrained	Calcaneus	Bandage	Night	01
		Bandage	No restraint during bath	01
		Tissue Sheet	Night	01
	Shoulder blade	Bandage	24 hours	01
	Sacrum	Bandage	24 hours	01
		Sheet	Morning	01
		Tissue	No restraint during bath	02
	Trochanter	Bandage	24 hours	01
		Tissue	No restraint during bath	01

Variable	Prevalence of restraint when the factor is not present		Prevalence of restraint when the factor is present		p-value	OR	CI of the OR
Variable	f	%	f	%	p-value	OR	CI of the OR
Male gender	13/98	13.3	8/64	12.5	0.887	0.9	0.4-2.4
Caregiver
Family member	11/56	19.6	10/106	9.4	0.066	0.4	0.2-1.1
Formal caregiver	14/128	10.9	7/34	20.6	0.154^(b)	2.1	0.8-5.7
Nursing Technician	17/147	11.6	4/15	26.7	0.109^(b)	2.8	0.8-9.7
Nursing Assistant	16/139	11.5	5/23	21.7	0.185^(b)	2.1	0.7-6.5
Caregiver’s routine
Morning	15/132	11.4	6/30	20.0	0.229^(b)	2.0	0.7-5.5
Afternoon	20/152	13.2	1/10	10.0	1.000^(b)	0.7	0.1-6.1
Night	18/146	12.3	3/16	18.8	0.468	1.6	0.4-6.3
On alternate days	16/155	10.3	5/7	71.4	0.000	21.7	3.9-121
Every day	11/57	19.3	10/105	9.5	0.077	0,4	0.2-1,1
Walks	17/79	21.5	4/83	4.8	0.002	05	0.1-0.6
Adequate Accessibility	10/58	17.2	11/104	10.6	0.226	0.6	0.2-1.4
Wheelchair	18/121	14.9	3/41	7.3	0.213	0.5	0.1-2.6
Bed Restriction	8/120	6.7	13/42	31.0	0.000	6.3	2.4-16.6
Permanent Bladder Catheterization	17/155	11.0	4/7	57.1	0.006^(b)	10.8	2.2-52.5
Gastrostomy	14/131	10,7	7/30	23.3	0.075^(b)	2.5	0.9-7.0

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author
Rosimere Ferreira Santana rosifesa@gmail.com