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Mechanical Restraint Use and Fall-related Injuries among Residents of Skilled Nursing Facilities

Mary E. Tinetti, MD; Wen-Liang Liu, MPH; and Sandra F. Ginter, RNC
[+] Article, Author, and Disclosure Information

Grant Support: In part by a grant from The Cox Foundation, Boston, Massachusetts, and gifts from the J.T. Posey Company, Arcadia, California, and Skil-Care Corporation, Yonkers, New York. Dr. Tinetti is a Kaiser Foundation Faculty Scholar.

Requests for Reprints: Mary E. Tinetti, MD, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, P.O. Box 3333, New Haven, CT 06510-8056.

Current Author Addresses: Dr. Tinetti: Department of Medicine, Yale University School of Medicine, 333 Cedar Street, P.O. Box 3333, New Haven, CT 06510-8056.

Mr. Liu and Ms. Ginter: Gerontology Research Group, 45 College Street, New Haven, CT 06510.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(5):369-374. doi:10.7326/0003-4819-116-5-369
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Objective: To evaluate the association between mechanical restraint use and the occurrence of injurious falls among persons residing in skilled nursing facilities.

Design: Prospective observational cohort study.

Setting: Twelve skilled nursing facilities in southern Connecticut.

Participants: The 397 persons who were mobile and unrestrained at baseline.

Measurements: Restraint use was defined both as the number of days restrained and as "never," "intermittently," or "continually" restrained. The primary outcome measure was the occurrence of a serious fall-related injury. Analyses were done on the entire cohort as well as on a subgroup hypothesized as having a high risk for falls.

Main Results: During one year of follow-up, 122 subjects (31%) became restrained, 83 intermittently and 39 continually. A serious fall-related injury was experienced by 5% (15 of 275) of unrestrained, compared with 17% (21 of 122) of restrained, subjects (chi-square= 12.478; P < 0.001). Restraint use remained independently associated with serious injury after adjusting for other factors, both in the entire cohort (adjusted odds ratio, 10.2; 95% Cl, 2.8 to 36.9) and in the high-risk subgroup (adjusted odds ratio, 6.2; Cl, 1.7 to 22.2). Among the 305 subjects who experienced two or fewer falls, the proportion having a serious injury was 15% for restrained subjects compared with 4% for unrestrained subjects (difference in proportions 11%, Cl, 4% to 17%), whereas the comparable proportions for the 92 subjects who experienced more than two falls were 20% and 16%, respectively. Results were similar in the high-risk subgroup.

Conclusions: Mechanical restraints were associated with continued, and perhaps increased, occurrence of serious fall-related injuries after controlling for other injury risk factors. Study results suggest the need to consider whether restraints provide adequate, if any, protection.





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