Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department

• Published in: The American journal of geriatric psychiatry 2025-01, Vol.33 (1), p.1-14
• Main Authors: Jivalagian, Patelle, Gettel, Cameron J., Smith, Colin M., Robinson, Leah, Brinker, Morgan, Shah, Dhruvil, Kumar, Anusha, Faustino, Isaac V., Nath, Bidisha, Chang-Sing, Erika, Taylor, R. Andrew, Kennedy, Maura, Hwang, Ula, Wong, Ambrose H.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; agitation; Black or African American; chemical sedation; Cross-Sectional Studies; emergency department; Emergency Service, Hospital - statistics & numerical data; Ethnicity; Female; geriatric psychiatry; health disparities; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hispanic or Latino; Humans; Hypnotics and Sedatives; Male; physical restraint; Psychomotor Agitation; Restraint, Physical - statistics & numerical data; Retrospective Studies; United States; White
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2024.07.004

•What is the primary question addressed by this study?What are the patterns of chemical sedation and physical restraint use in the geriatric population in emergency department settings?•What is the main finding of this study?This retrospective, cross-sectional study found that there is an increased odds of chemical sedation and physical restraint use with increasing older age as well as Black race and Hispanic/Latinx ethnicity.•What is the meaning of the finding?Within the geriatric population, older adults and those from historically marginalized backgrounds may be more vulnerable to sedation and restraint use in the emergency settings, which may make these already high-risk populations even more susceptible to worse health outcomes. Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population. This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015–2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint. Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29–1.42); 1.82 (1.73–1.91); 2.35 (2.15–2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27–1.34); 1.55 (1.50–1.60); 1.69 (1.59–1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18–1.35); AOR 1.22 (1.15–1.29)] and physical restraint [AOR 1.12 (95% CI 1.07–1.16); 1.22 (1.18–1.26)]. Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further researc