Abstract
Physical restraints are frequently used in elderly care and justified to prevent falls, control disruptive behavior and allow interventions. Physical restraints do not bring benefit, being associated with poor outcomes like direct injuries, reduced mobility and mortality. We have implemented an intervention multilevel program involving all the health care team of an acute care Alzheimer unit (SOMADEM) to reduce the use of physical restraints and to promote methods for achieving safety. SOMADEM (SOMAtic and DEMentia) is an 18-bed unit in a geriatric hospital. Patients admitted in this unit have dementia and at the same time behavioral and psychological symptoms of dementia (BPSD) due to a concomitant acute somatic disease. The intervention model has a longitudinal design in 3 phases: education, specialized consultation and physical restraints alternatives. The educational part consists in a 4-hour training of all unit staff taught by a specialized interdisciplinary team. The content covers risk of falls, management of disruptive behavior, legal issues regarding physical restraints prescription, alternatives to its use and discussion of clinical vignettes. A weekly specialized consultation by the same team proposes alternative ways. Prevalence of physical restraints after the intervention program is the primary outcome; evaluation of types of physical restraints, falls and fall-related injuries, psychoactive drugs prescription, disruptive behavior, functional independence status and destination after discharge are secondary outcomes. Data during the 12 months after the start of intervention will be compared to a 15-month period before the intervention used as baseline. Encouraging results will be discussed.