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David Mittleman
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Use of Physical Restraints With Elderly Patients Leads to More Harm Than Good

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Dealing with elderly patients can be difficult and unpredictable, but according to a growing body of medical research restraining patients to prevent them from pulling out tubes or falling can do more harm than good. In fact, most of these studies show that restraints cause more psychological or physical harm to elderly patients, who may already feel frightened in an unfamiliar medical setting.

A National Institute of Health report (.pdf) cited five major concerns over the use of restraints, particularly for elderly patients. First, restraints don’t actually prevent patients from falling and instead can cause strangulation, pressure sores, and decreased physical functioning if used for long periods of time. These are just some of the adverse side effects of restraints to patients, but nurses also experience deleterious effects. For example, in acute medical settings where restraints are used nurses often suffer from anxiety, feelings of inadequacy, hopelessness, and guilt, amongst other negative emotional responses. Finally, the use of physical restraints also goes against nurses’ codes of conduct of beneficence and autonomy–or the pledge to only do good for the patient and the right of the patient to choose their own course of action.

Rather than using physical restraints, with their abundance of problems, it is suggested that medical staff use other alternatives to help patients in nursing homes. Specifically, wandering is a frequently reported problem in nursing home settings (.pdf), but with proper monitoring, assessment of the patient and the environment, electronic surveillance systems, and specific interactions to limit patients’ wandering behaviors this problem can be remedied without the use of physical restraint.