Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis
Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic co...
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| description | Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p |
| doi_str_mv | 10.1371/journal.pone.0276504 |
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Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83). Conclusions The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0276504</identifier><identifier>PMID: 36288382</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Adults ; Aged patients ; Antipsychotics ; Autoregressive models ; Benzodiazepines ; Best practice ; Care and treatment ; Cohort analysis ; Constraints ; Coronaviruses ; Correlation coefficient ; Correlation coefficients ; COVID-19 ; Dementia ; Dementia disorders ; Demographic aspects ; Disease transmission ; Gloves ; Hospitalization ; Hospitals ; Intensive care ; Medical records ; Medicine and Health Sciences ; Mental disorders ; Nursing homes ; Older people ; Pandemics ; Patients ; People and Places ; Physical restraints ; Psychoses ; Psychosis ; Psychotropic drugs ; Public health ; Research ethics ; Restrictions ; Time series ; Trends ; Variability</subject><ispartof>PloS one, 2022-10, Vol.17 (10), p.e0276504-e0276504</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Jones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Jones et al 2022 Jones et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c669t-360f99a5dbc95415258821a1a8505ee92a6175b4b09487710bfb6ab000b1e7b03</citedby><cites>FETCH-LOGICAL-c669t-360f99a5dbc95415258821a1a8505ee92a6175b4b09487710bfb6ab000b1e7b03</cites><orcidid>0000-0002-6282-3614 ; 0000-0002-5296-6013</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604990/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604990/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids></links><search><creatorcontrib>Jones, Aaron</creatorcontrib><creatorcontrib>Goodarzi, Zahra</creatorcontrib><creatorcontrib>Lee, Justin</creatorcontrib><creatorcontrib>Norman, Richard</creatorcontrib><creatorcontrib>Wong, Eric</creatorcontrib><creatorcontrib>Dasgupta, Monidipa</creatorcontrib><creatorcontrib>Liu, Barbara</creatorcontrib><creatorcontrib>Watt, Jennifer</creatorcontrib><title>Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis</title><title>PloS one</title><description>Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83). Conclusions The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.</description><subject>Adults</subject><subject>Aged patients</subject><subject>Antipsychotics</subject><subject>Autoregressive models</subject><subject>Benzodiazepines</subject><subject>Best practice</subject><subject>Care and treatment</subject><subject>Cohort analysis</subject><subject>Constraints</subject><subject>Coronaviruses</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>COVID-19</subject><subject>Dementia</subject><subject>Dementia disorders</subject><subject>Demographic aspects</subject><subject>Disease transmission</subject><subject>Gloves</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Intensive care</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Mental disorders</subject><subject>Nursing homes</subject><subject>Older people</subject><subject>Pandemics</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physical restraints</subject><subject>Psychoses</subject><subject>Psychosis</subject><subject>Psychotropic drugs</subject><subject>Public health</subject><subject>Research ethics</subject><subject>Restrictions</subject><subject>Time series</subject><subject>Trends</subject><subject>Variability</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7jr6DwQDgujFjEmapokXwjD4MbCw4NdtOG3TaYZMMybp4vgb_NGmM1V2ZC-kF2mS57wnOXlPlj0leEHykrzeusH3YBd71-sFpiUvMLuXXRKZ0zmnOL9_6_8iexTCFuMiF5w_zC5yToXIBb3Mfq06vTM1WAR9g_bdIRwnXofowfQRDUGjZvCm3yCoh6hRDV6jzoW9iWDNT4jG9ci1yNlGewTNYGN4g5ZJIvpE6TqamxTlOucjCnFoDsdU0ew0CtobHdIcbEocHmcPWrBBP5nGWfb1_bsvq4_zq-sP69Xyal5zLuM857iVEoqmqmXBSEELISgBAqLAhdaSAidlUbEKSybKkuCqrThUGOOK6LLC-Sx7dtLdWxfUVMigaEmFlIKXI7E-EY2Drdp7swN_UA6MOi44v1Hgo6mtVlyyFnArSskoKzAVNZN5QVsh86rkLUtab6dsQ7XTTa37VFp7Jnq-05tObdyNkhwzKcfDvJwEvPs-pJdROxNqbS302g3Hc8uCMMF4Qp__g959u4naQLqA6VuX8tajqFqWlJFciGSVWba4g0pfMzomua41af0s4NVZQGKi_hE3MISg1p8__T97_e2cfXGL7TTY2AVnh9F54RxkJ7BOzgtet3-LTLAam-ZPNdTYNGpqmvw3SZ8I0A</recordid><startdate>20221026</startdate><enddate>20221026</enddate><creator>Jones, Aaron</creator><creator>Goodarzi, Zahra</creator><creator>Lee, Justin</creator><creator>Norman, Richard</creator><creator>Wong, Eric</creator><creator>Dasgupta, Monidipa</creator><creator>Liu, Barbara</creator><creator>Watt, Jennifer</creator><general>Public Library of Science</general><general>Public Library of Science 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and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis</title><author>Jones, Aaron ; Goodarzi, Zahra ; Lee, Justin ; Norman, Richard ; Wong, Eric ; Dasgupta, Monidipa ; Liu, Barbara ; Watt, Jennifer</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-360f99a5dbc95415258821a1a8505ee92a6175b4b09487710bfb6ab000b1e7b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adults</topic><topic>Aged patients</topic><topic>Antipsychotics</topic><topic>Autoregressive models</topic><topic>Benzodiazepines</topic><topic>Best practice</topic><topic>Care and treatment</topic><topic>Cohort analysis</topic><topic>Constraints</topic><topic>Coronaviruses</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>COVID-19</topic><topic>Dementia</topic><topic>Dementia disorders</topic><topic>Demographic aspects</topic><topic>Disease transmission</topic><topic>Gloves</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Intensive care</topic><topic>Medical records</topic><topic>Medicine and Health Sciences</topic><topic>Mental disorders</topic><topic>Nursing homes</topic><topic>Older people</topic><topic>Pandemics</topic><topic>Patients</topic><topic>People and Places</topic><topic>Physical restraints</topic><topic>Psychoses</topic><topic>Psychosis</topic><topic>Psychotropic drugs</topic><topic>Public health</topic><topic>Research ethics</topic><topic>Restrictions</topic><topic>Time series</topic><topic>Trends</topic><topic>Variability</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jones, Aaron</creatorcontrib><creatorcontrib>Goodarzi, Zahra</creatorcontrib><creatorcontrib>Lee, Justin</creatorcontrib><creatorcontrib>Norman, Richard</creatorcontrib><creatorcontrib>Wong, 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Monidipa</au><au>Liu, Barbara</au><au>Watt, Jennifer</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis</atitle><jtitle>PloS one</jtitle><date>2022-10-26</date><risdate>2022</risdate><volume>17</volume><issue>10</issue><spage>e0276504</spage><epage>e0276504</epage><pages>e0276504-e0276504</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83). Conclusions The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>36288382</pmid><doi>10.1371/journal.pone.0276504</doi><tpages>e0276504</tpages><orcidid>https://orcid.org/0000-0002-6282-3614</orcidid><orcidid>https://orcid.org/0000-0002-5296-6013</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adults Aged patients Antipsychotics Autoregressive models Benzodiazepines Best practice Care and treatment Cohort analysis Constraints Coronaviruses Correlation coefficient Correlation coefficients COVID-19 Dementia Dementia disorders Demographic aspects Disease transmission Gloves Hospitalization Hospitals Intensive care Medical records Medicine and Health Sciences Mental disorders Nursing homes Older people Pandemics Patients People and Places Physical restraints Psychoses Psychosis Psychotropic drugs Public health Research ethics Restrictions Time series Trends Variability |
| title | Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-11T16%3A49%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Chemical%20and%20physical%20restraint%20use%20during%20acute%20care%20hospitalization%20of%20older%20adults:%20A%20retrospective%20cohort%20study%20and%20time%20series%20analysis&rft.jtitle=PloS%20one&rft.au=Jones,%20Aaron&rft.date=2022-10-26&rft.volume=17&rft.issue=10&rft.spage=e0276504&rft.epage=e0276504&rft.pages=e0276504-e0276504&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0276504&rft_dat=%3Cgale_plos_%3EA724138805%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2728998670&rft_id=info:pmid/36288382&rft_galeid=A724138805&rft_doaj_id=oai_doaj_org_article_694fa0f8794245028c49352f893b76f4&rfr_iscdi=true |