CONSEQUENCES OF PHYSICAL RESTRAINTS

描述（由申请人提供）：在国家许可证和认证机构进行的养老院检查中，身体约束被定义为一种附加的设备，居民不能轻易移除，限制了行动自由和/或正常进入他/她的身体。 1989年，据估计，疗养院中44%的居民受到身体限制。 最近的研究表明，养老院中13%的居民现在受到身体限制。 由于使用约束手段的不良后果，人们担心人身约束手段仍被过度使用。 这些不良后果包括福尔斯、院内感染、压疮、住院医师躁动和认知能力下降。 仍有待调查的一个研究领域是使用人身限制与心理健康之间的关系。 以前的研究使用有限的统计检验，如相关性和t检验，不能解释潜在的偏见，如是否成为精神障碍的居民最有可能受到限制。 我们建议使用线性模型的变化，不太容易受到这种偏见。 这些先前的研究奠定了心理健康下降和身体约束使用的基础，但这个问题仍有待进一步研究。 建议使用最新可用的最小数据集（MDS），代表在宾夕法尼亚州的养老院居民，检查使用身体限制，认知能力下降，情绪改变，行为问题和社会参与之间的关联。 显然，了解约束是否有助于心理健康问题是重要的心理健康和护理质量的背景下。 如果约束导致心理健康下降，那么可能会产生更有力的理由来谨慎使用约束，从而有助于减少约束的使用。 在这些情况下，居民的健康和满意度也可能得到改善。 据推测，随着居民心理健康问题的减少，养老院可能能够更好地为受损居民提供心理健康（和其他）服务。

DESCRIPTION (PROVIDED BY APPLICANT): In nursing home inspections conducted by state licensure and certification agencies, a physical restraint is defined as a device that is attached and cannot be easily removed by the resident which restricts freedom of movement and/or normal access to his/her body. In 1989, it was estimated that 44 percent of all residents in nursing homes were physically restrained. More recent research suggests that 13 percent of all residents in nursing homes are now being physically restrained. Because of the adverse consequences of restraint use, there is concern that physical restraints are still being overused. These adverse consequences include falls, nosocomial infections, pressure sores, agitation of residents, and cognitive decline. One area of research that remains to be investigated is the nexus between the use of physical restraints and mental health. Previous studies use limited statistical tests, such as correlations and t-tests, that could not account for potential biases, such as whether residents who become mentally disturbed are most likely to be restrained. We propose to use linear models of change that are less susceptible to this bias. These prior studies laid the groundwork of mental health decline and physical restraint use, but this issue remains to be investigated further. It is proposed to use the newly available Minimum Data Set (MDS), representing nursing home residents in Pennsylvania, to examine the association between use of physical restraints, cognitive decline, alterations in mood, behavior problems, and social engagement. Clearly, understanding whether restraints contribute to mental health problems is important in a mental health and quality-of-care context. If restraints contribute to a decline in mental health, a more powerful rationale for their careful use may develop, helping reduce restraint use. In these cases, the health and satisfaction of residents may also be improved. Presumably, with a concomitant reduction in residents with mental health problems, nursing homes may be better able to provide mental health (and other) services to impaired residents.