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Physical activity and successful aging
10th International EGREPA Conference

European Group for Research into Elderly and Physical Activity

14.09. - 16.09.2006 in Köln

Physical restraint use among nursing home residents - a multicentre observational study

Meeting Abstract

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  • corresponding author S. Köpke - University of Hamburg, Germany
  • G. Meyer - University of Hamburg, Germany
  • I. Mühlhauser - University of Hamburg, Germany

Physical activity and successful aging. Xth International EGREPA Conference. Cologne, 14.-16.09.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06pasa057

The electronic version of this article is the complete one and can be found online at:

Published: December 18, 2006

© 2006 Köpke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Questionnaire studies indicate physical restraint prevalences of 40 percent and more in German nursing homes. Restraints are commonly applied as protective devices, mainly for the prevention of falls. However, several studies have shown that physical restraints are associated with a number of negative outcomes such as pressure ulcers, deconditioning, and incontinence. Direct observation has been reported the most valid and reliable method of data collection on physical restraints. High quality epidemiological data from direct observation are lacking; incidence has never been investigated. We examined prevalence and incidence of restraints and legal justification of devices in a representative sample of nursing home residents in Hamburg, Germany. Possible associations between residents' and institutional characteristics and physical restraints were investigated.


30 nursing homes were recruited representing 20 percent of the long-term care facilities in Hamburg. Prevalence was obtained by direct observation of physical restraints on three occasions on one day. A researcher accompanied by a staff nurse documented restraints using a specially developed, pre-tested documentation sheet. All residents of the nursing home present on at least one prevalence visit were included. Justification of devices was collected by medical chart review. Prospective incidence collection is ongoing.


A total of 2,367 residents were included. Age ranged from 40 to 107 years, with a median of 87 years; 82% were women. Median length of stay was 29 months (range 0 to 404 months). Centre prevalence ranged from 4 to 59%. Cluster-adjusted prevalence of residents with at least one restraint device was 26.2% (95% confidence interval 21.3%-31.1%). Bedrails were most commonly used (24.5%). Fixed tables, belts, and other devices were observed in 2.1%, 2.7%, and 2.3% of residents, respectively. 39.5% of restraints were justified by a judge, 14.9% by written residents' consent, and 11.9% by residents' oral consent according to nurses' statement. 16.6% of restraints were applied due to nurses' or legal guardians' decision, 2.8% due to relatives' and 3.3% due to physicians' decision. High level of care dependency, severe cognitive impairment, and fracture during the preceding 12 months were significantly associated with the use of restraints. None of the institutional characteristics examined was associated with increased use of restraints.


Prevalence of physical restraints is lower than previously reported in German and European questionnaire studies. However, a considerable number of nursing home residents are still restrained from physical activity. Respect for residents' autonomy and freedom and well-documented unfavourable effects of physical restraints demand a systematic reduction approach. Therefore, the development of a practice guideline is in progress, which aims to reduce the number of physical restraints and inter-centre variations.