Manfredini Laetitia, Pépin Marion, Ayar Pradeebane Vaittinada, Gay Matthieu, Certin Marie, Ayar Prabakar Vaittinada
Emergency Department, Beaujon Hospital AP-HP, Clichy, France.
Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.
BMC Geriatr. 2025 Jan 14;25(1):30. doi: 10.1186/s12877-025-05689-z.
The worldwide population is ageing and self-arm can be prevented with many techniques. Among them coercive measure consisting of physical restraint (PR) is one of the techniques. This study aims to assess the effects of the biological sex on the long-term survival after PR in geriatric patients during the initial emergency department (ED) visit.
This retrospective study included patients between November 2019 to March 2021. All consecutive hospitalized patients after emergency department visit older than 75 years with PR were included. The population was compared according to the biological sex. One-year all-cause mortality was plotted with the Kaplan-Meier curve. Hazard ratios (HRs) for 1-year mortality were calculated using a Cox proportional hazards regression model. Mortality was monitored over a 3-year period.
PR was used in 149 patients representing 4.6% of 3210 hospitalized patients older than 75 years after ED visit. Women represented 52% of the study population. Compared to men, women were older [median (IQR) age 89 (85-93) vs. 85 (81-90) years, P = 0.002]. Women more often presented dementia (93 vs. 80%, P = 0.031). Both sexes presented the same limited independence. All-cause mortality was significantly lower for women than men after one year (25 vs. 51%, respectively, P = < 0.001). Likewise, adjusted HR of 1-year all-cause mortality was higher in men [a HR 3.4 (95% confidence interval 1.7-7.1), P < 0.001].
This study suggested that the use of physical restraint in older adults was a more related factor of mortality in men than women. Women were older with lower expectancy life but PR use seemed to be a sign of global health decline in men. Further prospective studies are needed to assess if mortality after PR use is a cause or a consequence of a global health decline.
全球人口正在老龄化，许多技术可预防自我伤害。其中，包括身体约束（PR）在内的强制措施是其中一种技术。本研究旨在评估生物学性别对老年患者在首次急诊科（ED）就诊时接受PR后的长期生存的影响。
这项回顾性研究纳入了2019年11月至2021年3月期间的患者。纳入所有在急诊科就诊后年龄超过75岁且接受PR的连续住院患者。根据生物学性别对人群进行比较。用Kaplan-Meier曲线绘制1年全因死亡率。使用Cox比例风险回归模型计算1年死亡率的风险比（HRs）。在3年期间监测死亡率。
149例患者使用了PR，占急诊科就诊后年龄超过75岁的3210例住院患者的4.6%。女性占研究人群的52%。与男性相比，女性年龄更大[年龄中位数（四分位间距）89（85-93）岁对85（81-90）岁，P = 0.002]。女性更常出现痴呆（93%对80%，P = 0.031）。两性的独立性都同样有限。1年后女性的全因死亡率显著低于男性（分别为25%和51%，P = <0.001）。同样，男性1年全因死亡率的调整后HR更高[a HR 3.4（95%置信区间1.7-7.1），P < 0.001]。
本研究表明，在老年人中使用身体约束对男性死亡率的影响比女性更大。女性年龄更大，预期寿命更低，但使用PR似乎是男性整体健康下降的一个迹象。需要进一步的前瞻性研究来评估使用PR后的死亡率是整体健康下降的原因还是结果。
