Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan

PLoS One. 2021 Nov 22;16(11):e0260446. doi: 10.1371/journal.pone.0260446. eCollection 2021.

Abstract

Introduction: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.

Methods: In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.

Results: In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government's announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic.

Conclusion: Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • Dementia / epidemiology
  • Dementia / therapy*
  • Female
  • Hospitals / statistics & numerical data
  • Humans
  • Japan
  • Male
  • Restraint, Physical / statistics & numerical data*

Grants and funding

This study was supported by JSPS KAKENHI Grant Number JP19H01075 from the Japan Society for the Promotion of Science, GAP Fund Program of Kyoto University type B, Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare, Japan [21IA1005], and Humanities, Social/Behavioral Sciences, and Natural Sciences Interdisciplinary Research Project of Kokoro Research Center from Kyoto University to Y.I. The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.