Relationship between restraint use, engagement in social activity, and decline in cognitive status among residents newly admitted to long-term care facilities

Freeman, Shannon, Spirgiene, Lina, Martin-Khan, Melinda and Hirdes, John P. (2016) Relationship between restraint use, engagement in social activity, and decline in cognitive status among residents newly admitted to long-term care facilities. Geriatrics and Gerontology International, 17 2: 246-255. doi:10.1111/ggi.12707


Author Freeman, Shannon
Spirgiene, Lina
Martin-Khan, Melinda
Hirdes, John P.
Title Relationship between restraint use, engagement in social activity, and decline in cognitive status among residents newly admitted to long-term care facilities
Journal name Geriatrics and Gerontology International   Check publisher's open access policy
ISSN 1447-0594
1444-1586
Publication date 2016-01-28
Year available 2016
Sub-type Article (original research)
DOI 10.1111/ggi.12707
Open Access Status Not Open Access
Volume 17
Issue 2
Start page 246
End page 255
Total pages 10
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 3306 Health (social science)
2909 Gerontology
2717 Geriatrics and Gerontology
Abstract Aim: Declining cognitive function can negatively affect residents' quality of life (QOL) in long-term care facilities (LTCFs). The present study examined the role of physical restraint use, use of antipsychotic medications, and engagement in social activities to affect change in cognitive status and drive cognitive decline among residents newly admitted to a LTCF. Methods: Secondary data analysis used interRAI Minimum Data Set 2.0 data gathered at admission and first follow-up assessment (n = 111,052). The interRAI Minimum Data Set 2.0 collects comprehensive information as part of regular clinical care, and is mandated for all LTCF in Ontario, Canada. Bivariate and logistic regression analyses investigated the roles of physical restraint use, antipsychotic medication use and social engagement affecting cognition, and were stratified based on the presence/absence of diagnosis of dementia. Results: At follow up, 16.1% of residents (n = 16 414) showed decline in cognition. Residents with one or more physical restraints (chair, trunk and limb) were at increased risk for cognitive decline evidenced among residents with and without a diagnosis of dementia. Antipsychotic medication use did not emerge as a strong predictor of cognitive decline. Social engagement was protective against cognitive decline, and more pronounced for residents without a diagnosis of dementia. Conclusion: Physical restraint use should be avoided, or used as a last resort. LTCFs should prioritize resident engagement in social activities in either formal activities or ad hoc, as soon as possible on entry to the LTCFs. Prioritizing social networks and greater participation in activities might decrease the risk for cognitive decline, thereby improving or maintaining resident quality of life. Geriatr Gerontol Int 2017; 17: 246–255.
Formatted abstract
Aim: Declining cognitive function can negatively affect residents' quality of life (QOL) in long-term care facilities (LTCFs). The present study examined the role of physical restraint use, use of antipsychotic medications, and engagement in social activities to affect change in cognitive status and drive cognitive decline among residents newly admitted to a LTCF.

Methods: Secondary data analysis used interRAI Minimum Data Set 2.0 data gathered at admission and first follow-up assessment (n=111,052). The interRAI Minimum Data Set 2.0 collects comprehensive information as part of regular clinical care, and is mandated for all LTCF in Ontario, Canada. Bivariate and logistic regression analyses investigated the roles of physical restraint use, antipsychotic medication use and social engagement affecting cognition, and were stratified based on the presence/absence of diagnosis of dementia.

Results: At follow up, 16.1% of residents (n=16414) showed decline in cognition. Residents with one or more physical restraints (chair, trunk and limb) were at increased risk for cognitive decline evidenced among residents with and without a diagnosis of dementia. Antipsychotic medication use did not emerge as a strong predictor of cognitive decline. Social engagement was protective against cognitive decline, and more pronounced for residents without a diagnosis of dementia.

Conclusion: Physical restraint use should be avoided, or used as a last resort. LTCFs should prioritize resident engagement in social activities in either formal activities or ad hoc, as soon as possible on entry to the LTCFs. Prioritizing social networks and greater participation in activities might decrease the risk for cognitive decline, thereby improving or maintaining resident quality of life
Keyword Antipsychotic agents
Cognition
InterRAI
Minimum data set
Physical
Restraint
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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