Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily. We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated. The prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7–88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1–87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents. The prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.
Background: The global pandemic of COVID-19 has required a population lockdown. Spain has one of the oldest/most aging populations in the world and was one of the most affected countries. We aim to describe the psychological and social implications as well as health-related behaviors as a result of the lockdown in community-dwelling older adults.Materials and Methods: Observational cross-sectional study. A total of 528 participants of over 60 years of age were recruited using snowball sampling technique during the lockdown of the COVID-19 first wave using an anonymous self-administered questionnaire composed of descriptive questions and validated scales for resilience (Brief Resilient Coping Scale) and emotions (Scale of Positive And Negative Experience).Results: Most participants (76.9%) live with other people and have an open space at home (64%). Only 33.7% continued doing activities to promote healthy aging, 65.7% did less physical activity and 25.6% increased their intellectual activity. Most of them (83%) used electronic communication with family and friends to a greater extent, and left the house to run basic errands. Greater scores on resilience showed significant negative correlations with age and negative feelings, and positive correlations with the size of the social network and positive feelings. Lacking an open space at home was associated with more negative feelings.Discussion: Older people are a vulnerable group severely affected by this pandemic crisis at multiple levels, requiring specific interventions to minimize the effects of changes in lifestyle that may be harmful. Detecting needs is essential to improve care and support from community health and social services, both nowadays and in future similar situations.
1 January 2012 in Archives of Gerontology and Geriatrics