Canada highest user of restraints on elderly
NationalPost.com – FP News – Canada highest user of restraints on elderly
March 19, 2009. Tom Blackwell, National Post
Canadian nursing homes are world leaders in confining their elderly residents with physical restraints, despite years of evidence that indicate such measures bring a host of negative side effects, a new study suggests.
Canadian homes and chronic-care hospitals used belts and other restraints on almost a third of residents: more than triple the rate in the United States and higher than the three other countries surveyed, the U.S.-led study found.
The figures are lower than a decade earlier, but suggest nevertheless that Canada should consider adopting the kind of strict nursing home legislation that has improved care in the United States, says a Canadian co-author of the research. “We have clear evidence that there is room for improvement,” said John Hirdes, a gerontology professor at the University of Waterloo. “On multiple levels, physical restraint leads to poor outcomes for elderly people.”
In fact, he said use of restraints – often on patients with dementia or other cognitive impairment – is considered by experts to be a sign of poor-quality care, and leads to harms ranging from loss of mobility to pressure ulcers and increased agitation.
Experts consider that a rate of restraint use below 5% is most appropriate, said Zhanlian Feng, a professor of community health at Brown University in Providence, Rhode Island, and lead researcher on the paper, just published in the International Journal of Geriatric Psychiatry.
“The Canadian rate is highest [in the study],” he noted. “That is not a good number.”
A spokesman for the long-term-care industry, however, said the study methodology misleadingly inflated the Canadian figures, and argued that homes are working hard to reduce use of restraints.
“This has been a continuing focus of the sector,” said Janet Lambert, executive director of the Ontario Long Term Care Association. “Our philosophy is that the least restraint should be used.”
She said the study includes statistics from several chronic care hospitals and they have less regulation and younger patients than nursing homes, both factors which could lead to greater use of restraints.
In Ontario, new legislation is imposing clear guidelines on nursing homes, while the province and industry are working on a Web-based system that would allow consumers to compare quality of care, and other factors, between facilities, said Ms. Lambert.
The new research dug up statistics from five countries — Canada, the United States, Finland, Hong Kong and Switizerland — on the application of physical restraints and prescribing of anti-psychotic medication, drugs whose use on senior citizens has become increasingly controversial.
The Canadian data came from 19 long-term-care homes and 41 continuing complex-care hospitals, mostly in Ontario, between 2003 and 2005. Prof. Hirdes said he believes the results are representative of the whole country.
Researchers found that physical restraints were used in Canadian homes on an average of 31.4% of residents in the previous seven days, compared to 6% in Switzerland, 9% in the United States, 20% in Hong Kong and 28% in Finland.
That is an improvement from a 1999 study that found rates of over 40% in Canada, said Prof. Hirdes, and more recent data from 2007 show even more progress. But it could be much better, he said.
Facilities say they use physical restraint most often to prevent falls, though research suggests it actually makes patients more susceptible to mishaps, said Prof. Hirdes. The reasons often have more to do with controlling harmful or disruptive behaviour, he said.
The study found that Canadian homes’ use of anti-psychotics — with about 27% of residents taking one of the drugs in the previous seven days — was in the middle of the five nations.
A number of studies recently have underlined the adverse effects of such drugs, including increased risk of falls, cardiovascular problems and death.
Prof. Hirdes said the use of physical or chemical restraints can be reduced in part by dealing with the patients’ underlying problems, such as bad eyesight or hearing or bothersome living conditions.
Physical restraint use was as high as it is in Canada before the U.S. law was implemented in the 1980s, setting out specific standards for curbing restraint use, he said.
The legislation links performance on issues like restraint use to funding from government bodies, said Prof. Feng. The U.S. Medicare and Medicaid programs — which provide health care to the elderly and poor — also have a Web site that allows consumers to compare how well every nursing home in the country is faring in each of several such areas, he said.
Such a site is coming in Ontario, while the province’s recently enacted Bill 140 is, in fact, imposing strict U.S.-style rules around physical restraint and other aspects of care, said Ms. Lambert.