Prevalence and risk factors for the use of physical and chemical restraints amongst older people living in residential care: data from the Hong Kong Longitudinal Study on Long-Term Care Facility Residents

Abstract

INTRODUCTION: Older people should be treated with respect, dignity, and compassion. However, older people are vulnerable to the restriction of their personal freedom by the use of physical and chemical restraints, which may negatively influence their physical and psychological well-being, and quality of life. OBJECTIVE: To investigate the prevalence and risk factors for the use of physical and chemical restraints amongst older people living in residential care in Hong Kong. METHODS: Data were obtained from the Hong Kong Longitudinal Study on Long-Term Care Facility (LTCF) Residents, between 2005 and 2012. Trained assessors (nurses, social workers and therapists) utilized the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data from 10 residential LTCFs. We used the data from residents who had their second annual assessment to ensure completeness of data over the previous 12 months. Use of chemical restraint was defined as receiving any of the 3 medications including anti-psychotic, anti-anxiety and hypnotic agents, during the previous 12 months. Use of physical restraint was defined as receiving any of the 5 restraining interventions including full bedside rails on all open sides of bed, other types of bedside rails used, trunk restraint, limb restraint, and the use of chair to prevent rising. Using a hierarchical logistic regression model, we assessed the incremental predictive power for: a) demographics (Model I); b) physical factors (Model II); c) cognitive factors (Model III); and d) psychiatric factors (Model IV) on the use of chemical and physical restraints. Ethical approval was granted by the IRB. RESULTS: We included 1,287 older people living in residential care. Mean (±SD) age was 83.2 (±8.4) years, 65% were females, 28% were married and 84% had primary education level or below. Mean Activities of Daily Living (ADL) score was 2.8 (±2.2, range 0-6). 10% experienced falls in the past 6 months, 8.4% were fed via nasogastric tube, 33% had dementia, 11% had psychiatric diseases, 3% had mental health history, and around 1% had mood disturbance, delusions, hallucinations, delirium or behavioural problems. Overall, 18.2% (range 11.5-22.5%) of the residents received chemical restraint, 58.8% (43.8-64.7%) received physical restrained, 63.1% (49.5-69.9%) received either chemical or physical restraint, and 13.9% (5.7-19.6%) received both. FOR CHEMICAL RESTRAINTS: Model I had no effects; Model II showed having more ADL impairment had higher odds; Model III showed having dementia, delirium and behavioural problems had higher odds; and Model IV showed having a mental health history, psychiatric diseases, delusions and hallucinations had higher odds. For physical restraints: Model I showed being older and married had higher odds; Model II showed having more ADL impairment had higher odds; Model III showed lower cognitive performance score (CPS) had higher odds; and Model IV showed psychiatric factors had no effects. For chemical or physical restraints: Model I showed older and married had higher odds; Model II showed having more ADL impairment had higher odds; Model III showed having dementia and cognitive impairment (lower Cognitive Performance Score) had higher odds; and Model IV showed having a mental health history and psychiatric diseases had higher odds. CONCLUSION: Restraint use was highly prevalent amongst older people living in residential care in Hong Kong. We found significant incremental predictive power for specific physical factors (ADL impairment), cognitive factors (cognitive impairment and dementia) and psychiatric factors (mental health and psychiatric diseases) on the use of chemical and physical restraints. These findings have important implications on the healthcare, social and ethical treatments of the older and vulnerable people living in residential care in Hong Kong.