- In a large retrospective cohort of 132,767 hospitalizations, limited English proficiency (LEP) was associated with higher adjusted odds of physical restraint or antipsychotic use.
- The disparity persisted despite similar unadjusted event rates between LEP and non-LEP groups, suggesting confounding by illness severity and hospitalization characteristics.
- Among patients with delirium, the association was stronger, underscoring the importance of communication in a syndrome that depends heavily on reorientation and nonpharmacologic management.
- The findings raise concern that language barriers may contribute to potentially avoidable escalation to restraints or antipsychotics, both of which carry recognized harms.
Study Background
Physical restraints and antipsychotic medications are generally considered last-resort interventions in hospitalized patients who are at immediate risk of harming themselves or others. In modern inpatient care, first-line management for agitation, confusion, and unsafe behavior emphasizes identifying reversible causes, providing environmental support, and using verbal de-escalation and reorientation. These approaches are especially important in delirium, where communication, reassurance, and repeated orientation can reduce distress and prevent escalation.
