[Dysphagia] Use of mittens

[eripley at yahoo.com (Irene Campbell-Taylor)]

Nursing homes, hospitals etc. are supposed to maintain a "least retrictive environment." but they seldom do.
  See:
  Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 55, Issue 1 S33-S40, 
              
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      ARTICLES

  Deficiency citations for physical restraint use in nursing homes
  NG Castle 
Institute of Health, Health Care Policy, and Aging Research, New Brunswick, New Jersey, USA. 
  OBJECTIVES: The average percentage of residents restrained in nursing homes is approximately 20%.( These include vests, belts, mittens, and wrist and ankle. Restraints and Posey vests.) Facilities that do not meet Health Care Financing Administration standards for restraint use may be issued a deficiency citation. This article investigates which structure and process factors of nursing homes are associated with a deficiency citation for restraint use. METHODS: Nationally representative data from the 1997 On-line Survey Certification of Automated Records are used, first, to provide descriptive analyses, and second, for logistic regression analyses of structure and process factors associated with a deficiency citation for restraint use. RESULTS: A total of 2,321 facilities were found to have at least one restraint deficiency citation, and 14,703 had none. After controlling for seven other key variables, five structural factors and six process factors are significant. The
 structural factors--larger bed size, for-profit ownership, and hospital based--were significantly associated with a higher likelihood of a deficiency citation for restraint use; whereas higher numbers of full-time equivalent specialists per resident and nurse aide training were significantly associated with a lower likelihood. The process factors--suctioning therapy, pain management, and bladder training--were significantly associated with a lower likelihood of a deficiency citation for restraint use; whereas intravenous therapy, higher use of catheters, and physical restraints were significantly associated with a higher likelihood of a deficiency citation. DISCUSSION: This analysis establishes linkages between structures and processes and the outcome of a deficiency citation for restraint use. The structural results may have some utility for regulators. They could be used to develop a specific program to target facilities most commonly found to have inappropriate
 restraint use. The process results may have some utility for providers who could use the information to target residents for review of inappropriate restraint use. 

   
             
  Mental Health Outcomes and Physical Restraint Use in Nursing Homes 
  Nicholas G. Castle
  Administration and Policy in Mental Health and Mental Health Services Research
  Volume 33, Number 6 / November, 2006 pages 696-704
  Abstract  We investigate the nexus between mental health outcomes in nursing home residents and the use of physical restraints. Previous studies in this area used limited statistical tests such as correlations and t-tests, that could not account for potential biases, such as residents who become mentally disturbed may be most likely to be restrained. We use propensity matching models that are less susceptible to this bias and data from the Minimum Data Set, representing approximately 2,000 residents over a period of 6 years. Our results clearly show that restrained residents are more likely to become more impaired with respect to cognitive performance, depression, and social engagement. We conclude that if facilities reduce restraint use then the prevalence of resident mental health problems will also likely decline.
   
   
  
  



   
   
   
  
 
   
  
   
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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