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

  • Miharu Nakanishi (a1), Yasuyuki Okumura (a2) and Asao Ogawa (a3)



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.


Corresponding author

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:


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All Japan Hospital Association (2016). Research project report on challenges for no use of physical restraint. Available at:; last accessed 22 August 2017.
Alzheimer's Disease International (2015). World Alzheimer report. The Global Impact of Dementia. An Analysis of Prevalence, Incidence, Cost and Trends. London, England: Alzheimer's Disease International.
Alzheimer's Disease International (2016). World Alzheimer report. Improving Healthcare for People Living with Dementia. Coverage, Quality and Costs Now and in the Future. London, England: Alzheimer's Disease International.
Barnett, R., Stirling, C. and Pandyan, A. D. (2012). A review of the scientific literature related to the adverse impact of physical restraint: gaining a clearer understanding of the physiological factors involved in cases of restraint-related death. Medicine, Science, and the Law, 52, 137142.
Castle, N. G. (2006). Mental health outcomes and physical restraint in nursing homes. Administration and Policy in Mental Health, 33, 696704.
Chang, Y. et al. (2016). Metabolically healthy obesity and development of chronic kidney disease. Annals of Internal Medicine, 164, 305312.
Crowther, J. E., Bennett, M. I. and Holmes, J. D. (2017). How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital? Age and Ageing, 46, 112118.
Enberg, J., Castle, N. G. and McCaffrey, D. (2008). Physical restraint initiation in nursing homes and subsequent resident health. The Gerontologist, 48, 441452.
Fogg, C., Meredith, P., Bridges, J., Gould, G. P. and Griffiths, P. (2017). The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study. Age and Ageing, doi: 10.1093/ageing/afx022.
Gaudreau, J. D., Gagnon, P., Harel, F., Tremblay, A. and Roy, M. A. (2005). Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. Journal of Pain and Symptom Management, 29, 368375.
Greenland, S. (1989). Modeling and variable selection in epidemiologic analysis. American Journal of Public Health, 79, 340349.
Handley, M., Bunn, F., and Goodman, C. (2017). Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review. BMJ Open, 7, e015257.
Hessler, J. B. et al. (2017). Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study. Epidemiology and Psychiatric Sciences, doi: 10.1017/S2045796016001098.
Hofmann, H. and Hahn, S. (2014). Characteristics of nursing home residents and physical restraint: a systematic literature review. Journal of Clinical Nursing, 23, 30123024.
Homma, A., Niina, R., Ishii, T., Hirata, N. and Hasegawa, K. (1989). Reliability and validity of the Japanese version of the GBS scale. Japanese Journal of Geriatrics, 26, 617623.
Krüger, C., Mayer, H., Haastert, B. and Meyer, G. (2013). Use of physical restraints in acute hospitals in Germany: a multi-centre cross-sectional study. International Journal of Nursing Studies, 50, 15991606.
Kurata, S. and Ojima, T. (2014). Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan. BMC Geriatrics, 14, 39.
Martin, L. S. et al. (2016). An education intervention to enhance staff self-efficacy to provide dementia care in an acute care hospital in Canada: a nonrandomized controlled study. American Journal of Alzheimer's Disease and Other Dementias, 31, 664677.
Ministry of Health, Labour, and Welfare (2011). A Manual for No Use of Physical Restraint. Available at:; last accessed 5 April 2017.
Ministry of Health, Labour, and Welfare (2015). A comprehensive strategy for the promotion of dementia measures-towards a community friendly to the elderly with dementia, etc-(a New Orange Plan). Available at:; last accessed 5 April 2017.
Nakanishi, M. et al. (2015). An evaluation of palliative care contents in national dementia strategies in reference to the European association for palliative care white paper. International Psychogeriatirics, 27, 15511561.
Nakanishi, M., Hirooka, K., Morimoto, Y. and Nishida, A. (2016). Quality of care for people with dementia and professional caregivers’ perspectives regarding palliative care in Japanese community care settings. International Journal of Geriatric Psychiatry, doi: 10.1002/gps.4620.
Nakanishi, M., Hoshishiba, Y., Iwama, N., Okada, T., Kato, E. and Talahashi, H. (2009). Impact of the elder abuse prevention and caregiver support law on system development among municipal governments in Japan. Health Policy, 90, 254261.
Ogawa, A. (2015). Japan Pharmacological Audit study of Safety and Efficacy in Realworld (Phase-R) Delirium Study. Available at:; last accessed 25 April 2017.
Rakhmatullina, M., Taub, A. and Jacob, T. (2013). Morbidity and mortality associated with the use of restraints: a review of the literature. The Psychiatric Quarterly, 84, 499512.
Reisberg, B. et al. (1984). Functional staging of dementia of the Alzheimer type. Annals of the New York Academy of Sciences, 435, 481483.
Sampson, E. L. et al. (2014). Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: prospective cohort study. The British Journal of Psychiatry, 205, 189196.
Sampson, E. L., Vickerstaff, V., Lietz, S. and Orrell, M. (2017). Improving the care of people with dementia in general hospitals: evaluation of a whole-system train-the-trainer model. International Psychogeriatrics, 29, 605614.
Sun, G. W., Shook, T. L. and Kay, G. L. (1996). Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. Journal of Clinical Epidemiology, 49, 907916.
Sze, T. W., Leng, C. Y. and Lin, S. K. (2012). The effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes: a systematic review. JBI Library of Systematic Review, 10, 307351.
Timmons, S. et al. (2015). Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition. Age and Ageing, 44, 993999.
van der Steen, J. T. et al. (2014). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European association for palliative care. Palliative Medicine, 28, 197209.
White, N., Leurent, B., Lord, K., Scott, S., Jones, L. and Sampson, E. L. (2017). The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study. International Journal of Geriatric Psychiatry, 32, 297305.
Windham, B. G. et al. (2015). Small brain lesions and incident stroke and mortality: a cohort study. Annals of Internal Medicine, 163, 2231.
Zenkoku-Yokusei-Haishi-Kai. (2015). Research Project Report on follow-up survey on prevalence, approaches, and attitudes toward abolishment of physical restraint in residential care settings under the public long-term care insurance program. Available at:; last accessed 26 September 2017.


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

  • Miharu Nakanishi (a1), Yasuyuki Okumura (a2) and Asao Ogawa (a3)


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