Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium.
Int J Nurs Stud. 2019 Jan;89:39-45. doi: 10.1016/j.ijnurstu.2018.07.019. Epub 2018 Aug 23.
Although there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce.
To gain insight into the factors associated with restraints in older adults receiving home care.
A secondary analysis of a cross-sectional survey about restraint use in home care.
Older adults receiving home care in Belgium.
8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone.
A cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients' primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail.
Multivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948-3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212-3.925], transfer [OR = 2.131, 95% CI = 1.191-3.812] and continence [OR = 1.436, 95% CI = 0.925-2.231]; perceived risk of falling in the nurses' clinical judgement [OR = 1.994, 95% CI = 1.710-2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316-2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048-1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126-1.925], the informal caregiver's dissatisfaction with family support [OR = 1.339, 95% CI = 1.003-1.788]; patient's cognitive impairment [OR = 1.398, 95% CI = 1.290-1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219-1.641]. The nurses' perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses.
The study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver's decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care.
尽管有证据表明家庭护理中约束的使用正在增加，但针对这一环境中约束相关因素的研究却很少。
深入了解与接受家庭护理的老年人使用约束相关的因素。
对家庭护理中约束使用的横断面调查的二次分析。
比利时接受家庭护理的老年人。
从总共 45700 名老年人中随机抽取 8000 名受试者。样本的平均年龄（n=6397）为 80.6 岁，66.8%为女性，46.4%独居。
由比利时一家护理组织的患者初级保健护士对接受家庭护理的老年人使用约束情况进行横断面调查。使用广义估计方程的二元逻辑回归模型评估与约束使用相关的因素。额外的分析集中在有和没有非正式照顾者以及独居/与他人同住的亚组上。详细分析了 6397 名参与者的数据。
多变量逻辑回归表明，约束的使用与监督有关[比值比（OR）=2.433，95%置信区间（CI）=1.948-3.038]；日常生活活动能力依赖（即进食[OR=2.181，95%CI=1.212-3.925]、转移[OR=2.131，95%CI=1.191-3.812]和大小便自理[OR=1.436，95%CI=0.925-2.231]）；护士临床判断感知的跌倒风险[OR=1.994，95%CI=1.710-2.324]、日常行为问题[OR=1.935，95%CI=1.316-2.846]和少于日常行为问题[OR=1.446，95%CI=1.048-1.995]；非正式照顾者幸福感下降[OR=1.472，95%CI=1.126-1.925]、非正式照顾者对家庭支持不满意[OR=1.339，95%CI=1.003-1.788]；患者认知障碍[OR=1.398，95%CI=1.290-1.515]；以及多药治疗[OR=1.415，95%CI=1.219-1.641]。护士对跌倒风险、认知障碍（用认知表现量表观察）和监督的感知是所有分析中与约束使用一致相关的唯一变量。
研究结果提供了有关家庭护理中与约束使用相关的新的和特定于情境的因素的深入了解（例如监督、非正式照顾者幸福感下降和对家庭支持的不满）。这些见解可以支持开发减少家庭护理中约束使用的干预措施。
