Uso de sujeciones físicas en relación con el riesgo de caídas en una residencia de ancianos / Physical restraint use in relation to falls risk in a nursing home

ANTECEDENTES Y OBJETIVO: El uso de sujeciones físicas (SF) es común en el cuidado de los ancianos. Sin embargo, su eficacia y seguridad son cuestionadas por la evidencia científica. El objetivo de este estudio fue determinar el papel de las SF en la prevención de caídas. MATERIALES Y MÉTODOS: Se realizó un estudio de cohorte retrospectivo. Examinamos todas las caídas (n=575) que se produjeron en ancianos mayores de 65 años que residieron en una residencia entre febrero de 2009 y septiembre de 2013. Analizamos la asociación entre el uso de SF y riesgo de caídas mediante una regresión logística multivariable que ajusta las características de los residentes que se asociaron con el uso de SF según un análisis bivariado. RESULTADOS: Los factores de riesgo de caídas, teniendo en cuenta el uso de SF, fueron: riesgo de caída (Test de Tinetti) (OR 4,57; IC 95% 1,76-11,75); capacidad de caminar (OR 6,40; IC 95% 2,78-14,74); déficit auditivo (OR 2,12; IC 95% 1,05-4,29); y la historia de caídas (17,81; IC 95% 8,83-35,93). El riesgo de caídas fue mayor en los residentes sujetos ambulantes con deterioro cognitivo (OR 18,95; IC 95% 7,06-50,85). No encontramos diferencias en las lesiones entre las caídas que ocurrieron con y sin SF. CONCLUSIONES: El uso de SF no se asoció significativamente con menos caídas y lesiones. En los residentes ambulantes con deterioro cognitivo podrían aumentar el riesgo de caídas. Por tanto, habría que considerar si las SF proporcionan una protección adecuada contra el riesgo de caídas

BACKGROUNDS AND OBJECTIVES: The use of physical restraints (PR) is common in the care of the elderly. However, their efficacy and safety are not supported by scientific evidence. The aim of this study was to determine the role of PR in preventing falls. MATERIALS AND METHODS: A retrospective cohort study design was used, in which each fall incident (n=575) was examined in the residents over 65 years of age who resided at the one nursing homes from February 2009 to September 2013. An analysis was made of the association between the use of PR and risk of falls using a multivariate logistic regression, adjusting for the characteristics of residents that were associated with the use of PR according to a bivariate analysis. RESULTS: Risk factors for falls after accounting for PR use, include: risk of falling (Tinetti test) (OR 4.57; 95% CI 1.76-11.75); ability to walk (OR 6.40; 95% CI 2.78-14.74); hearing impairment (OR 2.12; 95% CI 1.05-4.29); and history of a previous fall (OR 17.81; 95% CI 8.83-35.93). The risk of falls was greater in restrained, ambulatory residents with cognitive impairment (OR 18.95; 95% CI 7.06-50.85). No differences were found in injuries between falls that occurred with and without PR. CONCLUSIONS: Restraint use was not significantly associated with fewer falls and injuries. The risk of falls could increase in ambulatory residents with cognitive impairment. The study results suggest the need to consider whether restraints provide adequate protection against the risk of falls

[Physical restraint use in relation to falls risk in a nursing home]. / Uso de sujeciones físicas en relación con el riesgo de caídas en una residencia de ancianos.

BACKGROUNDS AND OBJECTIVES: The use of physical restraints (PR) is common in the care of the elderly. However, their efficacy and safety are not supported by scientific evidence. The aim of this study was to determine the role of PR in preventing falls. MATERIALS AND METHODS: A retrospective cohort study design was used, in which each fall incident (n=575) was examined in the residents over 65 years of age who resided at the one nursing homes from February 2009 to September 2013. An analysis was made of the association between the use of PR and risk of falls using a multivariate logistic regression, adjusting for the characteristics of residents that were associated with the use of PR according to a bivariate analysis. RESULTS: Risk factors for falls after accounting for PR use, include: risk of falling (Tinetti test) (OR 4.57; 95% CI 1.76-11.75); ability to walk (OR 6.40; 95% CI 2.78-14.74); hearing impairment (OR 2.12; 95% CI 1.05-4.29); and history of a previous fall (OR 17.81; 95% CI 8.83-35.93). The risk of falls was greater in restrained, ambulatory residents with cognitive impairment (OR 18.95; 95% CI 7.06-50.85). No differences were found in injuries between falls that occurred with and without PR. CONCLUSIONS: Restraint use was not significantly associated with fewer falls and injuries. The risk of falls could increase in ambulatory residents with cognitive impairment. The study results suggest the need to consider whether restraints provide adequate protection against the risk of falls.