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Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

Published online by Cambridge University Press:  10 November 2017

Miharu Nakanishi*
Mental Health and Nursing Research Team, Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
Yasuyuki Okumura
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
Asao Ogawa
Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
Correspondence should be addressed to: Miharu Nakanishi, PhD, Mental Health and Nursing Research Team, Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan. Phone/Fax: +81-3-6834-2292. Email:



In April 2016, the Japanese government introduced an additional benefit for dementia care in acute care hospitals (dementia care benefit) into the universal benefit schedule of public healthcare insurance program. The benefit includes a financial disincentive to use physical restraint. The present study investigated the association between the dementia care benefit and the use of physical restraint among inpatients with dementia in general acute care settings.


A national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was “use of physical restraint.”


Among patients, the point prevalence of physical restraint was 44.5% (n = 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]).


The financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.

Original Research Article
Copyright © International Psychogeriatric Association 2017 

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