The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study.

BACKGROUND: Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily. METHODS: We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated. RESULTS: The prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7-88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1-87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents. CONCLUSIONS: The prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.

[Use of physical restraints on the elderly: attitudes, knowledge and practice among nursing staff]. / Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores.

OBJECTIVES: To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. MATERIAL AND METHODS: A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. RESULTS: A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals' attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient's history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. CONCLUSIONS: The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved.

Determinants of specific food consumption in the Canary Islands (Spain).

The consumption of specific functional foods (FF) and some determinants of FF item selection were assessed using a questionnaire administered to 1112 individuals in the Canary Islands (Spain). Food items considered were Milk products: easily digestible milk (or milk low in lactose), milk enriched with vitamins and/or minerals, skimmed milk with soluble fiber, milk with royal jelly, milk with modified fatty acids (omega 3), milk products low in fat, pro-biotic foods (yoghurt and fermented milk) and yoghurt with phytosterols; Cereals: fortified breakfast cereals, wholemeal cereals and energy bars; Drinks: juices and enriched drinks, stimulating drinks and isotonic drinks; DHA-enriched, low cholesterol eggs; Meat products: low salt sausages and cooked low fat ham; Fats: enriched margarine, margarine rich in phytosterols and sunflower oil rich in oleic acid; Condiments: iodated salt. These food items were organized into 7 FF groups (milk products, cereals, fortified drinks, DHA eggs, meat product, fats, condiments). The results indicated that the highest prevalence was fortified drinks (63.6%; 95% CI: 60.7-66.5). Overall FF consumption prevalence was 80.1% (95% CI: 77-83): single FF item consumption being rare. There were significant inter-group relationships, and some group intakes (milk products, cereals and drinks) were related to age but with no overall relationship between consumption and age. The education level was significantly related to the consumption of cereals, drinks, meat products and condiments (χ2 test p = 0.04). Some specific FF item consumption segregated with environment (rural or urban) but with no overall significant relationship between the FF group and environment or gender.

[Barthel and Charlson indexes for the prognosis of mortality and institutionalization in hospitalized geriatric patients]. / Indice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia.

INTRODUCTION: To compare the validity of the Barthel (BI) and Charlson comorbidity index (CCI) as well as the age-adjusted CCI for the prognosis of mortality and institutionalization in hospitalized geriatric patients. MATERIAL AND METHODS: A retrospective study was conducted to evaluate patients admitted to an acute care geriatric ward and mid-term care facility in 2006 (n=343). The independent variables were the admission BI (registered in the clinical history in all patients) and the CCI and the age-adjusted CCI, which were registered "a posteriori" using the available information. The outcome variable was mortality or institutionalization when the patient was discharged. The sensitivity and specificity values for each of the cut-off points selected from the scales analyzed were recorded and ROC curves were constructed for each of these points; the area under the curve (AUC) with a confidence interval (CI) of up to 95% was calculated. RESULTS: The mean age was 82.3 years (58.6% women). The AUC was 0.736 (95% CI=0.68-0.79) for the BI, 0.61 (95% CI=0.55-0.67) for the CCI and 0.625 (95% CI=0.56-0.69) for the age-adjusted CCI. Statistically significant differences were found among the AUC of the BI compared with that of the other two indexes (p<0.01). CONCLUSIONS: As predictors of mortality and institutionalization, the BI was superior to the CCI and the age-adjusted CCI. The BI could therefore be more useful than the other two indexes when considering an adequate use of healthcare services.

[Descriptive study of the attitudes of family caregivers to the use of physical restraints: preliminary results]. / Estudio descriptivo sobre la actitud de la familia ante el uso de restricciones físicas en mayores: resultados preliminares.

OBJECTIVE: To evaluate the attitudes of families caring for elderly dependents to the use of physical restraints and to identify the factors that could influence these attitudes. MATERIAL AND METHODS: A descriptive, cross sectional study was carried out in a consecutive sample of the population, using a questionnaire investigating the various aspects that influence attitudes to restraints. Responses were obtained from 50 family caregivers, of which seven were discarded due to lack of knowledge about restraints (N=43). The characteristics of the sample, frequencies, the main trends and dispersion measures were analyzed. RESULTS: Most of the family caregivers considered the use of restrains to be appropriate and 90.7% were willing to use them with a relative; 41.9% believed that their use was unavoidable and were unaware of alternatives, while 23.3% were unaware that physical restraints can cause physical and psychological problems. None of the family caregivers believed that this method of restraint was a form of abuse. CONCLUSIONS: Relatives had a positive attitude to physical restraints and considered their use appropriate. This finding could be related to their limited knowledge of alternatives and of the complications that can be caused by restraints. Training programmes on alternatives to these devices should be instigated.

[An extended version of the Font-Roja job satisfaction questionnaire]. / Una propuesta destinada a complementar el cuestionario Font-Roja de satisfacción laboral.

INTRODUCTION: Several studies have shown the need to include the physical work environment among the dimensions included in job satisfaction evaluation. However, this dimension was not included in the Font-Roja questionnaire. The present study introduces two items exploring this dimension and adheres to the hypothesis that physical work environment has a significant impact on job satisfaction evaluation. METHOD: A total of 227 geriatric workers participated in this study. The participants completed the Font-Roja job satisfaction questionnaire with 2 additional items exploring the physical work environment. Factor analysis and principal components analysis with rotation varimax were used to determine the diverse components of job satisfaction. To determine the coherence of the scales and the consistency of the added items, Cronbach's a was used. These methods were applied to both questionnaires, the classical 24-item questionnaire and the extended 26-item questionnaire. RESULTS: The classical Font-Roja questionnaire was composed of 8 factors, explaining 60.02% of the variance. The extended questionnaire was structured into 9 factors, explaining 61.81% of the variance. The new factor was composed of both added items. The internal consistency of the Font-Roja classical scale was alpha = 0.773 and that of the extended scale was alpha = 0.791. DISCUSSION: The extended scale is superior to the classical scale. The results obtained seem to support the hypothesis that, for analysis of job satisfaction, the instruments used should contain items on the physical work environment.