109 Few people are aware of the adverse and even harmful effects of physical restraint. The physiological effects of simple immobility- caused by restraints have been well characterized.110,111 Immobility causes decreased muscle mass, which results in weakness, loss of balance, and, along with bone demineralization, increases the risk of falls and fractures. Additionally, the metabolic rate slows, and circulatory

responses can include decreased cardiac output, increased Inhibitors,research,lifescience,medical risk of blood clots, and orthostatic hypotension. Any of these conditions can create a decreased breathing volume, which can result, in pneumonia, a leading cause of death in the elderly. Common side effects of immobility include constipation, increased skin breakdown and infections, and increased confusion. There have been no successful legal claims against, longterm care facilities based solely on the failure to restrain a resident.112 Additionally, it is believed that the movement of Federal regulations towards the least-restrictive environment, possible will impact, future Inhibitors,research,lifescience,medical liability claims. Finally, it. is unrealistic Inhibitors,research,lifescience,medical to believe that it. takes less time to supervise and protect a resident, in restraint. Studies by Blakcslee et al have determined that residents in restraints actually take an estimated 4.58 hours

per day of personal attention to comply with restraint standards of care, compared with 2.7 hours per day of personal attention needed when the restraints were removed.109 Inhibitors,research,lifescience,medical The initial step to changing the use of restraints must involve all levels of staff, including physicians, administrators, and nonnursing

staff. Written guidelines should clearly state the facility’s policy and these should be shared with all staff, family members, volunteers, visitors, funding sources, and regulators. A second step involves education and replacing myths Inhibitors,research,lifescience,medical with accurate information. The final step is identifying alternative options for managing and accepting the resident’s behavior. There is no one “right” answer, but staff should be encouraged to develop, implement, and assess innovative approaches. Alternatives to physical restraints often fit into one of four categories: medical treatment, find protocol environmental modifications, behavioral interventions, and rehabilitative measures.113 Special care units The Office of Technology Montelukast Sodium defines these as specially designed environments with skilled staff to provide ongoing care and programs addressing the special needs of patients with Alzheimer’s disease. There has been a growing trend for nursing homes to offer specialized programming for residents with dementia. Termed “special care units” (SCUs), these programs vary enormously from specifically designed freestanding facilities with highly trained staff to institutions that simply have one wing that segregates residents with dementia from the physically frail. The first SCU opened in 1974 at the Philadelphia Geriatric Center.