Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.
PLoS One. 2021 Nov 22;16(11):e0260446. doi: 10.1371/journal.pone.0260446. eCollection 2021.
The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.
In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.
In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government's announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic.
Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.
冠状病毒病（COVID-19）大流行给全球医务人员带来了前所未有的挑战，尤其是在收治 COVID-19 阳性患者的医院中工作的医务人员。日本政府宣布 COVID-19 医院限制措施后，医院护理受到了多种限制，包括更多地使用身体约束，这可能会影响老年痴呆症患者的护理。然而，很少有研究从实证角度验证 COVID-19 大流行期间使用身体约束的影响。我们旨在评估大流行后监管变化对急性护理医院老年痴呆症患者使用身体约束的影响。
在这项回顾性研究中，我们提取了 2019 年 1 月 6 日至 2020 年 7 月 4 日期间在急性护理医院接受痴呆症护理的老年患者（年龄>64 岁）的数据。我们根据患者是否入住收治 COVID-19 阳性患者的医院将患者分为两组。我们计算了描述性统计数据来比较每 2 周的趋势，并进行了中断时间序列分析来验证身体约束使用的变化。
在收治 COVID-19 阳性患者的医院中，自政府宣布后，每 1000 次住院中有身体约束的患者人数增加，在宣布后第 73 周至第 74 周期间，每 1000 次住院中有 501.4 名患者被身体约束，达到峰值。此外，在收治 COVID-19 阳性患者的医院中，老年痴呆症患者使用身体约束的情况显著增加（p=0.004）。需要个人护理的老年痴呆症患者在 COVID-19 大流行期间身体约束的使用显著增加。
了解导致痴呆症患者身体约束使用增加的原因和机制有助于为类似的未来情况设计更有效的护理方案。
