Elderly patients are at risk of falling, especially when entering an unknown residence and especially at night. Further, various medications may increase risk of falling. Does this mean that patients at risk require restraints? In the past, hospitals and nursing homes often used hand and ankle restraints which caused patients severe agitation and fright and actually increased the risk of falling. Today, the least restrictive means is used to ensure safety which include preventative measures such as bed alarms which signal when a patient is trying to get out of bed or a wheelchair; chemical restraints such as sedatives which reduce agitation and confusion; lap belts which are not tight fitting and, rather than restrain a patient, are a gentle reminder to stay seated in a chair; or, use of a sitter, either a relative or aid who remains at the bedside for a 24 hour period.
If physical restraints are used, they must be ordered by a physician and reordered every 24 hours. Statistical data documents that falls are less likely to occur when the least restrictive measures are used. All patients must be assessed for falls at the time of admission to hospitals or nursing homes, and appropriate measures must be used to prevent injury; however, physical restraints are the measure of last resort.