Restraining Restraint Use for Older Adults in Alberta Emergency Services

Older adults are frequent users of the emergency department (ED) contributing to high rates of ED revisitation and the longest lengths of stay in the ED. Agitation is more common in older adults, which contributes to increased risk of hospital admission and ICU admission. Overall, older adults are more likely to present acutely unwell, delirious, or agitated - all of which increase the use of both physical and chemical restraints. Nearly 80% of restrained older adults have a primary medical illness, with less psychiatric illness than younger persons. The high proportion of older adults presenting to emergency medical services (EMS) who are restrained represents a significant source of preventable injury for our most vulnerable citizens. We lack evidence describing the scope and harm of restraint use for older adults with EMS and in the ED. Our overarching goal is to understand how to optimize quality of care for older adults experiencing agitation with EMS and in the ED. To reduce restraints use in the ED, we aim to use an integrative knowledge translation approach to address two objectives. 1) Understand the frequency and harm associated with physical and chemical restraint use for older adults with EMS and in the ED. This will be done via a retrospective cohort study looking at patient and system outcomes. 2) Understand barriers and facilitators to reducing restraint use with EMS and in the ED from the perspectives of persons with lived experience, care-partners, and providers. We will complete semi-structured qualitative interviews to gain in-depth understanding of stakeholders’ experiences. This project will develop the necessary evidence and understanding that will inform the design of an implementation strategy aimed at reducing restraint use in Alberta and close the knowledge gap in our current understanding of restraint use with EMS and in the ED.