Exercising restraint.

The article focuses on exercising restraint in acute medical wards in Cleveland, Ohio. The issues in the care of the elderly in institutions, particularly the confused, who are likely to be there in part because they are known to be at risk but who are all too easily discounted and abused, are clearer than the answers. Undue restraint is stultifying, overprotective, even cruel, Laissez-faire permissiveness, on the other hand, is thoughtless, dangerous and negligent. Restraint patients were eight times more likely to die during hospitalization than those not restrained. The only independent predictor of restraint among the variables assessed was cognitive impairment. Presumably the best compromise is to use as little restraint as is compatible with good care, to use the least noxious restraints and to seek alternatives.