What is a major safety concern associated with using restraints in older adults, and what is a preferred alternative approach?

• A. Restraints can limit movement but improve safety.
• B. Restraints can cause harm and dignity issues; preferred alternatives include close supervision, environmental modifications, and bed/chair alarms.
• C. Restraints increase cognitive function but cause dehydration.
• D. Restraints are necessary in all cases to prevent falls.

Answer: (B)

Restraints in older adults raise safety concerns because they can cause real harm and threaten dignity, often doing more harm than protection. Physical restraints can lead to injuries from falls, skin breakdown, reduced circulation, nerve damage, or even complications like aspiration if positioning is improper. They can also worsen confusion, agitation, and anxiety, and strip away a person’s independence and sense of control, which can impede cooperation with care.

The safer approach is to minimize restraint use and rely on alternatives that keep people safer without restricting movement. This includes close supervision or one-to-one monitoring when risk of wandering or pulling at tubes exists; environmental modifications to reduce hazards—like clear walkways, adequate lighting, uncluttered spaces, non-slip floors, lower bed heights, and easy access to the call light; and the use of bed or chair alarms to alert staff promptly. Addressing pain, providing meaningful activities, ensuring proper hydration and sleep, and using mobility aids as needed are also important. Restraints should only be used when absolutely necessary and for the shortest duration, with continual reassessment.