Mechanical Restraint in Older Adults on Acute Psychiatric Wards: A Registry Study of Patterns and Recurrence

Background: Mechanical restraint remains a common coercive practice in acute psychiatric wards and is particularly concerning in older adults due to greater physical and cognitive vulnerability. Methods: We conducted a retrospective observational study using routinely collected registry data from all recorded mechanical restraint episodes in 20 acute adult mental health inpatient units in the Andalusian public health system over 30 months. Among 2,435 restrained individuals with documented age, 19.4% (n=473) were ≥55. Age was modelled as a continuous predictor of (i) repeated restraint (any subsequent episode) and (ii) multiple restraints (≥3 episodes) using mixed-effects logistic regression with random intercepts for unit and adjustment for sociodemographic, diagnostic, and episode-related factors. Results: Compared with younger users, older restrained users were more often female and Spanish, more frequently had bipolar disorder and organic/intellectual disability diagnoses, and less often had substance use or personality disorders. They experienced a longer time from admission to the first restraint. Restraint was more often recorded as “required for another therapeutic activity” and less often due to “aggressive behavior”. During restraint, older users more frequently displayed confusion, and episodes more often began at night. Repeated restraint occurred in 27.2% of subjects; younger age was significant in univariable analysis but not after adjustment (aOR 1.004). Multiple restraint occurred in 23.0%; after adjustment, older age was associated with lower odds (aOR 0.992). Conclusions: Older adults showed a distinct restraint profile, supporting age-sensitive restraint-reduction strategies focused on frailty/confusional states in older individuals and preventing repeated episodes in younger users.