Interventions to reduce restrictive practices in residential aged care homes: a scoping review

BACKGROUND: A restraint-free environment is a human right for people living in residential aged care (RAC). Yet restrictive practices continue to be frequently used in these settings. A scoping review of interventions is required to inform future practice and research. OBJECTIVE: To identify and characterise interventions that have been implemented to reduce the use of restrictive practices on residents of RAC. METHODS: A scoping review was conducted of peer reviewed articles that reported on interventions implemented in RAC to reduce restraint use. Databases searched included Ageline, CINAHL, Medline, PubMed, PsycINFO, Scopus, Embase. Bronfenbrenner's Socio-Ecological Model (SEM) was used to characterise and present the interventions. RESULTS: Seventy studies were included; 52 studies addressed one SEM level (macro-system, exo-system or micro-system) and 18 studies addressed two SEM levels (exo-system and meso‑system; exo-system and micro-system). No interventions were identified at the meso‑system level. Educational interventions were the most frequently recorded (31 studies), although there was a lack of detail in the reporting. Reductions in physical restraint were maintained over time, with varied outcomes regarding chemical restraint. CONCLUSION: Reduction in restraint use in RAC is complex, although most interventions focused on one SEM level of influence only. Positively, studies consistently reported reductions in physical restraint over time, reinforcing the benefits of implementing targeted interventions to reduce restraint use. Further research is needed to examine the benefits of interventions targeting multiple SEM levels and considering all forms of restraint. Findings from this review can inform future interventional studies to reduce restraint use in RAC. REVIEW REGISTRATION: Open Science Framework https://osf.io/7v4b2.