[Use of physical restraints in the elderly in an emergency department. Analysis of clinical, environmental and health care team organization factors associated with decision making]

Objetive: To determine the influence of different factors involved in the decision to apply physical restraints (PR) in the management the elderly people with conduct disorders in an emergency department (ED) METHODS: A prospective observational study was conducted in the ED of the Hospital Universitario Severo Ochoa (Leganés, Madrid). We included 125 elderly people with disruptive behaviors and collected clinical, patient handling, organizational and environmental variables. Individuals who had undergone PR were analyzed to learn what factors were related to the final decision to restrain.

Results: 32.8% of the participants underwent PR. The aspects that most influenced the decision to restrain were those related to the organization and environment: specific staff training decreased the probability of restraint by 50% (P<.05) and good support from the whole team reduced the risk of using SF by up to 75% (P<.0005). Related patient handling factors such as verbal restraint, pain relief, family accompaniment and early mobilization significantly reduced the use of PR (P<.05). The only patient-dependent clinical aspect that increased the risk of SF was male sex (P<.05). Other factors unrelated to the probability of applying PR were, among others, nurse-patient ratio, type of behavior, age, or functional/cognitive status.

Conclusions: Exclusively clinical factors of the patient had little influence on the decision to restrain the elderly in an ED. However, environmental, organizational, and behavioral handling variables could favor more respectful alternatives and thus reduce the use of PR in the elderly with disruptive behaviors in the ED.