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Objectives: To explore the prevalence and associated factors of involuntary treatment (physical restraints, psychotropic medication, nonconsensual care) in persons with cognitive impairment receiving home care., Design: Cross-sectional survey using association analyses., Setting: Professional home care in the southern part of the Netherlands., Participants: Data were collected on 837 persons with cognitive impairment (mean age 81.6; 60% female)., Measurements: Involuntary treatment was measured using a tool to identify physical restraints, psychotropic medication, and nonconsensual care. Activities of daily living (ADLs) were measured using the ADL Hierarchy subscale of the Resident Assistant Instrument-Minimum Data Set and cognitive status using the Cognitive Performance Scale. Informal caregiver burden was assessed using the Self-Perceived Pressure from Informal Care Scale., Results: Involuntary treatment was used in 39% of the total sample. Most common were nonconsensual care (79%; e.g., concealing medication in food, forcing hygiene) and psychotropic medication (41%). In 7% of the sample, physical restraints (e.g., deep or overturned chair, bilateral full-enclosure bedrails) were used. Caregiver burden, ADL dependency, cognitive status, living alone, and a diagnosis of dementia were strongly associated with involuntary treatment. The family of the person with cognitive impairment most often requested the use of involuntary treatment., Conclusion: Involuntary treatment is often used in persons with cognitive impairment receiving home care in the Netherlands. Future research should focus on understanding and preventing inappropriate involuntary treatment in home care., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

The use of physical restraints still is highly prevalent in institutional long term care settings for older people. We know that the use of restrictive measures, such as belt restraints, do have many negative consequences for residents, and even can be harmful to their health. However, this knowledge does not result in a reduction of physical restraints. This paper describes the search for an intervention (EXBELT) aiming to safely reduce and prevent the use of belt restraints in nursing homes. EXBELT consists of a promotion of institutional policy change that discourages use of belt restraints, nursing home staff education, availability of alternative interventions, and consultation by a nurse specialist. Effect evaluations show that EXBELT is effective on the short and long term. According to a process evaluation, EXBELT was largely performed according to protocol and very well received by nursing home staff and resident's relatives. However, concurrently it is stated that the reduction of physical restraints in Dutch nursing home care runs slowly. The conclusion is that continuing focus is needed to reduce physical restraints in nursing homes and to prevent its use in home care.

Objective: The current study describes the process evaluation of a multicomponent intervention program (Expelling Belts [EXBELT]) to reduce the use of belt restraints in psychogeriatric nursing homes. The aim was to assess the feasibility and ascertain suggestions for optimization of the EXBELT program., Design: A descriptive study comprising longitudinal elements., Setting: Fifteen psychogeriatric nursing home wards in 6 Dutch nursing homes., Participants: The study population consisted of 4 different groups of participants who took part in the intervention arm of the quasi-experimental study examining the effectiveness of EXBELT: nursing home staff who attended the final session of the educational program; 2 nurse specialists who delivered the educational program and did the consultations; 4 groups of delegates representing the nursing home associations where the EXBELT program was implemented; and the relatives of those residents in the intervention group who were restrained with a belt at the start of the study., Measurements: Both quantitative and qualitative data were collected from the study population. Data were assessed by means of self-administered questionnaires, recording forms, group interviews, telephone interviews, and monthly meetings., Results: The EXBELT study was largely performed according to protocol and very well received by nursing home staff as well as resident's relatives. Suggestions to improve the EXBELT program include the addition of examples of how to communicate about the policy change, improving the reach of the intended target population, adding more case-based learning strategies, and embedding the available consultants more proactively., Conclusions: The implementation of EXBELT was highly successful in the current research population and is likely to be feasible in psychogeriatric nursing homes in general., (Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.)

Objectives: To assess the long-term effects of the EXBELT intervention program, which was designed to reduce belt restraint use and was found to be effective immediately after implementation, after 24 months., Design: Quasi-experimental longitudinal design., Setting: Thirteen nursing homes: seven assigned to control group and six to intervention group., Participants: A panel group (n = 225) of residents present at baseline and 24 months after baseline and a survey group (n = 689) of all residents present 24 months after baseline. The survey group included the panel group., Intervention: EXBELT included four components: a policy change, an educational program, consultation, and availability of alternative interventions., Measurements: The use of belt restraints 24 months after baseline was the primary outcome measure. Secondary outcomes included other types of physical restraints. An independent observer collected data four times during a 24-hour period., Results: EXBELT resulted in a 65% decrease in belt use between baseline and 24 months after baseline in the panel group (odds ratio 0.35, 95% confidence interval = 0.13-0.93; P = .04). In the survey group, the proportion of residents using belts was 13% in the control and 3% in the intervention group (P < .001) 24 months after baseline. The use of the most restrictive types of restraints was significantly lower in the intervention group than the control group in the panel and survey groups., Conclusion: The EXBELT intervention was associated with long-term minimization of belt restraint usage in older nursing home residents. A multicomponent intervention including institutional policy change, education, consultation, and the availability of alternative interventions had an enduring effect on successful restraint reduction., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)

Background: Physical restraints are commonly used in psychogeriatric nursing home residents despite reports of negative consequences. Most research has focused on restraint reduction without addressing methods to prevent initiation of restraints in nursing homes. EXBELT has been found to decrease belt restraint use but should also be evaluated for its use in preventing restraints., Objective: To investigate the effectiveness of the EXBELT intervention to prevent the use of belt restraints on psychogeriatric residents newly admitted to nursing homes., Design: Quasi-experimental study design., Setting: Twenty-six nursing home wards from thirteen Dutch nursing homes., Participants: Newly admitted residents (n=104) during a four month period., Interventions: Fifteen wards (intervention group) implemented the EXBELT intervention, which consisted of four components: a policy change, education, consultation and the availability of alternative interventions., Methods: Data on the use of belt restraints, other types of physical restraints, falls and fall-related injuries and psychoactive drug use were collected at T2 (4 months) and T3 (8 months) after baseline (T1) for those resident who were newly admitted after baseline and before T2 (4 months). Physical restraint use data were collected by a trained, blinded observer four times during a 24-h period., Results: A total of 104 residents were newly admitted after baseline (T1) and before T2. Of those, 82 were present on T2 and T3. Informed consent was obtained from legal representatives of 49 out of the 82 residents. In the control group (n=20), 15% and 20% used belts at T2 (4 months) and T3 (8 months), respectively. In the intervention group (n=29), these proportions were 3% and 0%, respectively (OR=0.08; 95% CI (0.01-0.76); p=0.03). There was no increase in the intervention group in the use of other physical restraints, falls and fall-related injuries or psychoactive drug use., Conclusion: The EXBELT intervention effectively seems to prevent the use of belt restraints in newly admitted residents in psychogeriatric nursing homes., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes., Design: A quasi-experimental longitudinal design. Study duration was 8 months., Setting: Twenty-six psychogeriatric nursing home wards in 13 Dutch nursing homes were assigned to intervention or control groups., Participants: Seven hundred fourteen residents were selected for participation. Legal representatives of 520 residents agreed on participation; complete data are available for 405 residents., Intervention: The intervention program included four major components: promotion of institutional policy change that discourages use of belt restraint, nursing home staff education, consultation by a nurse specialist aimed at nursing home staff, and availability of alternative interventions., Measurements: The primary outcome measure was the frequency of belt restraint use. Secondary outcomes included other types of physical restraints, psychoactive drug use, falls, and fall-related injuries. These data were collected at baseline and after 4 and 8 months. A trained, blinded observer measured the use of belts and other physical restraints types four times during a 24-hour period., Results: The intervention resulted in a 50% decrease in belt use (odds ratio = 0.48, 95% confidence interval = 0.28-0.81; P = .005). No increase occurred in the use of other types of restraints. No marked differences between the groups were found regarding psychoactive drugs, falls, and fall-related injuries., Conclusion: A multicomponent intervention program led to a substantial reduction in use of belts, full-enclosure bedrails, and sleep suits without increasing the use of other physical restraints, psychoactive drugs, or falls and fall-related injuries., (© 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.)

Background: The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes., Methods and Design: Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT., Discussion: A quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes. We selected the wards in a manner that contamination between control- and intervention group is prevented., Trial Registration: (NTR2140).

Objectives: To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents., Design: Cluster-randomized trial., Setting: Fifteen psychogeriatric nursing home wards in the Netherlands., Participants: In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses., Intervention: The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level)., Measurements: Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set., Results: Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group., Conclusion: An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed.

Background: Although there is an urgent need for restraint-free care, the number of randomized clinical trials on preventing or reducing physical restraints has been limited., Objectives: To investigate the effectiveness of an educational intervention to prevent the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards., Design: Cluster-randomized trial., Setting: Fourteen Dutch psycho-geriatric nursing home wards., Participants: 138 residents admitted to 14 psycho-geriatric nursing home wards after baseline measurement of the trial were selected, out of which 33 residents died or informed consent had not been obtained. A total of 105 residents were included in the analyses., Methods: The nursing home wards were randomly assigned to either educational intervention or control status. The educational intervention consisted of an educational programme for nurses combined with a nurse specialist's consultation. The data were collected at 1, 4 and 8 months post-intervention. The use of physical restraints was measured by blinded, trained observers on four separate occasions over a 24-h period. The Minimum Data Set was used to determine residents' characteristics, such as their cognitive status., Results: During the study period, no statistically significant differences between the experimental group and the control group regarding restraint status, restraint intensity, multiple restraints and types of restraints were found. One month post-intervention, 38% of the residents newly admitted to the experimental wards were restrained. Bilateral bedrails were the most frequently used restraints at Post-test 1 (24%), Post-test 2 (23%) and Post-test 3 (28%), followed by the use of infrared systems at Post-tests 2 and 3., Conclusion: An educational programme combined with the consultation of a nurse specialist does not prevent the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards. Although other studies have shown promising results with the effectiveness of these types of intervention on restraint reduction, the development of additional interventions to prevent restraint usage is recommended.

Background: Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods. Therefore, reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important. The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents., Methods: A cluster randomized trial was applied to 5 psycho-geriatric nursing home wards (n = 167 residents with dementia). The wards were assigned at random to either educational intervention (3 wards) or control status (2 wards). The restraint status was observed and residents' characteristics, such as cognitive status, were determined by using the Minimum Data Set (MDS) at baseline and 1 month after intervention., Results: Restraint use did not change significantly over time in the experimental group (55%-56%), compared to a significant increased use (P < 0.05) in the control group (56%-70%). The mean restraint intensity and mean multiple restraint use in residents increased in the control group but no changes were shown in the experimental group. Logistic regression analysis showed that residents in the control group were more likely to experience increased restraint use than residents in the experimental group., Conclusion: An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term. However, the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group. Whether the intervention will reduce restraint use in the long term could not be inferred from these results. Further research is necessary to gain insight into the long-term effects of this educational intervention.

Aim: The aim of the study was to examine the prevalence of physical restraint use in cognitively impaired nursing home residents, the manner in which restraints are used, reasons for using them, and relationships between residents' characteristics and use of physical restraints., Methods: A point prevalence study was conducted on the use of physical restraints among all residents cared for in two Dutch nursing homes and one nursing home unit (n = 265). Data about the nursing home residents and the use of restraints were collected by means of a questionnaire, which was filled in by the nurses. The response rate was 98%. The mean age of residents was 81 years (sd = 8.6), 74% of whom were female., Results: One or more restraints were used with 49% of the residents. The most frequently used physical restraints were bed rails, a waist belt, and a chair with a table. In almost all situations (90%), residents were continuously restrained and restraints were used for longer than 3 months. The most common reason (90%) for use of restraints was to prevent falls. Logistic regression analysis revealed that use of restraints was highly associated with poor mobility, care dependency and risk of falling in the opinion of nursing staff., Conclusions: The results of this study are comparable with those of other studies. However, since recent studies have reported that physical restraints are inadequate to prevent falls, recommendations are made to re-evaluate critically the use of restraints and to conduct future research into a responsible and safe way of decreasing the use of physical restraints.