Physical restraints

Family member (FM): So now that my mother is practically unable to stand up and move by herself without the risk of bruises, what’s the next step?

Caregiver (CG): There’s what we call the passive physical restraint, which we use to avoid falls and contain agitation, especially at night.

FM: But what do you mean by physical restraint?

CG: To put it simply, it’s the use of means, methods, clothes or material that limit the voluntary capacity of the elderly to move their body, or part of it, for their safety and wellbeing, if they exhibit maladapted or harmful behaviors to themselves.

FM: They’re attached to a chair or something else?

CG: Oh no, there are different types of restraints like jackets, chest straps, belts, straps for wrists and ankles, adaptable seats, bed barriers and other ordinary materials like even a bed cover or a piece of clothes that would limit movement of the patient.

FM: This being said, and apart from bruises, what are the restraints used for then?

CG: We first and foremost think of the risk of falls in elderly people, and also usually restlessness and wandering.

FM: And what are the recommendations as to the use of restraints?

CG: That it would be established that the elderly person has a risk behavior for themselves or the others, and the knowledge of the kind of risk for which restraint would be recommended. For this, a regular assessment of the person’s needs and risks, and an individualized monitoring and care plan are put in place. This is done through the cooperation of the multidisciplinary team of health care providers like doctors, nurses, occupational therapists…

FM: And in case we use restraints, this would be a long-term action, wouldn’t it?

CG: No. Actually, though it’s used to avoid behavioral risks and consequences, we resort to it as little as possible, for as better use as possible, and for as less as possible during a specific period of time. And after having assessed the patient’s condition, we use the least restrictive method so as to maintain the patient’s functional activities.

FM: Who decides on the use of physical restraints?

CG: It’s a medical decision implying the multidisciplinary team, the patient if they’re cognitively aware, and their family, on an informed consent basis when other solutions are ruled out, like medication adaptation due to drug interactions, environmental modifications like removing loose rugs or any unnecessary equipment at home, and occupational approaches like maintaining physical and play activities and using bed hoists and grab bars, good lightening, hearing and visual aids and all that.

CG: Are there any risks related to the use of physical restraints then?

FM: Incontinence for example, bedsores, being bedridden, and also strangulation and suffocation. But this can be avoided as long as organizational strategies are implemented. Our care teams are professional and trained in the use of restraints and their possible adverse events.