Department of Health Research Methods, Evidence, and Impact, McMaster University Hamilton, Hamilton, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
PLoS One. 2022 Oct 26;17(10):e0276504. doi: 10.1371/journal.pone.0276504. eCollection 2022.
Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited.
To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use.
Retrospective cohort study with a time series analysis.
Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020.
We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR).
We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83).
The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.
化学和物理约束与老年人的伤害有关，但我们对其在急性住院期间的使用情况了解有限。
（1）描述 COVID-19 大流行期间老年患者在急性住院期间与大流行前相比约束的使用情况，（2）描述医院间约束使用的差异。
回顾性队列研究，时间序列分析。
2019 年 11 月 1 日至 2020 年 6 月 30 日期间，在加拿大艾伯塔省的 4 家医院或安大略省的 6 家医院之一出院的年龄在 65 岁或以上的急性住院患者。
我们使用自回归线性模型和限制立方样条来比较 COVID-19 大流行开始后与大流行前相比，化学约束（即精神药物，即抗精神病药、苯二氮䓬类和曲唑酮）和物理约束（如手套）的使用比例。我们使用组内相关系数（ICC）和中位数优势比（OR）来描述医院间约束使用的差异。
我们纳入了 71004 例住院患者。在调整痴呆和精神病障碍的流行率后，安大略省的医院中化学约束的使用从大流行前的平均 27.1%增加到 30.8%（p<0.001），但在 8 周内恢复到大流行前的水平。安大略省的物理约束订单从 5.9%增加到 8.3%（p=0.012），并在 8 周内保持升高。艾伯塔省没有观察到约束使用的显著变化。化学约束使用的医院间差异中等（ICC 0.041，中位数 OR 1.43）。物理约束使用的差异更大（ICC 0.11，中位数 OR 1.83）。
COVID-19 大流行对安大略省老年患者住院期间使用化学和物理约束产生了影响，但艾伯塔省没有。地区和医院之间在化学和物理约束使用方面存在显著差异，这表明有机会改善老年护理的最佳实践。未来的研究必须支持实施以证据为基础的干预措施，以标准化适当的约束使用。
