Despite decades of concern about their safety, effectiveness and appropriateness, physical restraints remain widely used in nursing homes particularly for residents with poor mobility, high dependency or dementia [1–4]. Death by asphyxiation or mechanical compression is the most horrific complication of physical restraint [5]. Recent reports, including one by Bellenger et al. in this issue, provide important new information about the frequency of such deaths [6, 7].

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In a study of Australian nursing home residents whose deaths were reported to a coroner over a 13-year period, five residents, all of whom had poor mobility and four of whom had dementia, died because restraints caused ‘neck compression and entrapment’ [6]. While any such death is horrifying,...

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