The Delirium Effect:
The Improper Use of Restraints in the Elderly

Abstract
This study examined the use of restraints in the elderly who were diagnosed with Delirium in a hospital setting. A major issue is the over utilization of restraints and the lack of appropriate, documented rationale. There were two types of methods used in this study, the pharmacologic and non-pharmacologic methods. Two test groups were chosen at random with permission from the family of the patients. One group was chosen for the pharmacologic portion and another group for the non-pharmacologic portion. For the pharmacologic portion, 126 elderly patients diagnosed with Delirium were given either haloperidol or a placebo. For the non-pharmacologic portion, 15 elderly patients with Delirium were provided with alternative treatment modalities such as the medical equipment and tubing were kept to a minimum or hidden away from the patients view, the call bell was within reach at all times, lighting in the room was dimmed, but adequate and the noise levels were well controlled. It was predicted that those receiving haloperidol and those receiving alternative treatment modalities would show improvement and have a reduced incident of restraint use. Those patients who received haloperidol showed improvement of symptoms and decreased need for restraint, those who received placebo did not. Those who had been chosen to receive alternative treatment modalities showed improvement of symptoms and decreased need for restraint.

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Introduction
Over the recent years, restraints and their utilization have become a priority issue in the healthcare industry. Many accreditation agencies, such as the Joint Commission and Centers for Medicare and Medicaid Services, have highlighted the improper use of restraints as a cause for concern. Lack of proper documentation is a primary concern, if it is not charted; legally it has not been done. Some of the issues being focused on is a lack of documentation of rationale for restraints, lack of physician order, lack of charting of events leading up to restraint use and lack of interventions attempted by staff to avoid restraint use, all of which are required when a patient is in restraints (“Provision of care, treatment, and services,” 2009). In addition, a focus is the use of restraints on elderly patients diagnosed with Delirium and the lack of alternative treatment modalities offered. How would the elderly with Delirium react to an antipsychotic such as haloperidol, would it decrease the need for restraints? Would haloperidol help their Delirium symptoms? Would therapeutic modalities that do not involve medication decrease the use of restraints? Would either treatment option decrease the duration of their Delirium?
According to Goethals, Sabine, Dierckx de Casterlé & Gastmans (2012) the reported frequencies of physical restraint use vary widely in the healthcare industry, making it almost impossible to determine the true prevalence of restraint use. Although often discussed as a major point of concern, it is quite surprising that the numbers of restraints utilized throughout this country is difficult to obtain. It could possibly be just a lack of proper data collection or a lack of reporting the use of restraints. All healthcare facilities fall under either the Joint Commission standards or the Medicare and Medicaid Services standards or both. “Provision of care, treatment, and services” (2009) explains that the Joint commission sets the standards and Medicare and Medicaid Services will follow and mirror their standards. With all institutions, falling under the same guidelines and with so many discrepancies this shows a true cause for concern.
Currently within the health care system, there are two types of restraints that are utilized. According to Provision of care, treatment, and services (2009) the new restraint standards are not divided into “non-behavioral” and “behavioral” categories.