Study finds low activity levels among nursing home residents regardless of restraint

The use of physical restraints in U.S. nursing homes has dropped dramatically since the 1990 implementation of federal regulations severely limiting the use of such devices. However, a new study reports there is little evidence that this freedom has led to increases in residents' activity levels or in rehabilitation programs that improve the problems that can result from restraint use.

The researchers involved in this study conducted their work on behalf of the Borun Center for Gerontological Research, a joint venture between the UCLA School of Medicine and the Jewish Home for the Aging of Greater Los Angeles. The results were published in the April issue of The Gerontologist (Vol. 44, No. 2).

Today an estimated 12 percent of nursing home residents are physically restrained, down from 40 percent in 1990. Although the danger of being injured by a restraining device has diminished, the clinical significance of restraint reduction is still questionable, the researchers say.

"Federal regulations to achieve restraint reduction were conceived largely as a means toward an end - the end being increased movement and physical activity among residents. Although we've made significant progress on the means, it doesn't seem to have gotten us much closer to the end. Perhaps we would reach that goal faster if we directly measured residents' physical activity levels," stated lead author John F. Schnelle, PhD, director of the Borun Center.

Nursing homes with a high rate of physical restraint use employ more restrictive care processes than facilities that use restraints less often. But this study - the first to independently evaluate the validity of a nursing home "prevalence of restraint" quality measure - also suggests that most long-stay residents spend a potentially unhealthful amount of time in bed.

"Based on our observations, we estimate that the typical resident in a high-restraint home spends between 19 and 20 hours in bed each day. That estimate drops in low-restraint homes, but by only an hour a day," said Schnelle. "The conclusion we draw is that all residents seem to be spending too much time in bed and not enough time engaged in activities that enhance mobility, gait, and balance."

The Gerontologist is a refereed publication of The Gerontological Society of America, the national organization of professionals in the field of aging.

The article abstract is available online at http://gerontologist.gerontologyjournals.org/cgi/content/abstract/44/2/245.

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