Pressed by changing attitudes, changing law and a growing protest from senior citizen groups, nursing homes around the country are reevaluating the practice of physically or chemically restraining many of their residents much of the time.

Such restraints are common in American nursing homes, two new reports confirm.

In a year-long study of 12 Connecticut nursing homes, Yale researchers found that physical restraints, such as elevated bed- rails or belts that strap a person to a chair, were used on 59 percent of the residents initially. Over the next year, 31 percent of the other residents were physically restrained in some fashion.

Another study, of 60 nursing homes in eight western states, found that about half of the use of tranquilizers was not medically justified and would violate new federal regulations that took effect last October. Both studies were published last month in the Journal of the American Medical Association.

On any given day, 500,000 older Americans in hospitals and nursing homes "are tied to their beds and chairs," two researchers from the University of Pennsylvania School of Nursing reported in 1989. Estimates of the prevalence of restraints in the nation's 1.5 million nursing homes range from 25 to 85 percent.

The argument for using restraints is usually made on the grounds of protecting people from falling out of bed or wheelchairs or from wandering or bothering other residents. But experts say that there is little scientific evidence that restraints actually prevent injuries. There is, however, evidence that they are often imposed unnecessarily and can cause emotional and physical harm.

One study of 120 hospitals found that two thirds of the "getting out of bed injuries" occurred in patients trying to climb over raised bedrails.

"The point about restraints such as bed- rails is that they mask the problem but they don't solve it," said Barbara Frank, associate director of the National Citizens Coalition for Nursing Home Reform. "All it means is you're going to fall harder when you climb on top of that bedrail."

Restraint use "involves a choice between safety and independence," the Yale researchers concluded. "Unfortunately, the decision is made with an almost complete lack of data concerning the effectiveness of restraints on reducing injury or improving behavior."

An accompanying editorial in the AMA journal said the high prevalence of restraint use "appears to be in serious conflict both with the principle of maximum independence and with the new law, which establishes the nursing home resident's right to be free from any physical restraints imposed on him or her to reduce staff effort or impose discipline."

The new rules, known as OBRA guidelines because they grew out of requirements Congress passed in 1987 as part of the Omnibus Budget Reconciliation Act, allow physical restraints only when medically necessary "to ensure the physical safety of the resident or other residents." Restraint for "discipline or convenience" is prohibited. The same standard of medical necessity applies to antipsychotic drugs, such as tranquilizers.

Under the OBRA rules, restraints can be imposed only after less restrictive alternatives -- such as pillows, pads, removable lap trays and quick-release belts -- have been tried, and then only temporarily and with the consent of the resident or guardian.

The new federal regulations are part cause and part effect of the "Untie the Elderly" movement, which seeks to reduce the use of restraints in nursing homes, said Carter Catlett Williams, a social worker who specializes in working with the elderly.

"While there are some people who frown and grimace and say it can't be done, there's also a tremendous response, because down underneath nobody has felt happy about this {issue}," said Williams, whose husband, T. Franklin Williams, is director of the National Institute on Aging. "We've all been uneasy about it."

Williams said she visited the Grabergets nursing home in Goteborg, Sweden, four years ago and was astonished by what she saw. In a 210-bed nursing home, she witnessed only one instance of physical restraint -- a man with a seatbelt on his wheelchair. The man, who requested the seatbelt, could unbuckle it himself at any time.

Ever since that visit, as part of a broad effort to make nursing homes more homelike and humane, Williams has been working to minimize use of physical restraints.

To Williams, restraints were the "outward sign of everything that was wrong with American nursing homes, in terms of a person not living in a dignified, self-respecting way."

The OBRA rules have caused a "sea change" in the nursing home industry, said Arnold Silverman, president of Skil-Care Corp. of Yonkers, N.Y., a leading manufacturer of long-term-care equipment, including restraints.

The trend is toward less restrictive equipment that either does not limit the personal freedom of a patient or can be controlled by the patient, Silverman said. "Basically, the industry restocked itself in the last four months," he said, as nursing homes across the country ordered cushions, trays, jackets, vests and belts designed to keep people from falling out of wheelchairs or beds without unduly restricting their mobility.

"The new OBRA guidelines have forced everybody to reevaluate the role of restraints in nursing homes," said Ernest Posey, Midwest sales manager for J.T. Posey Co., the nation's largest maker of long-term care equipment. The latest version of the "Posey self-assisting belt" -- which secures a person to a chair -- comes with a Velcro fastener that can be easily detached, much like a car seatbelt.

"Restraints have been overused in nursing homes," said Rebecca Elon, medical director of the Washington Home. The OBRA rules mainly require "common sense steps" to ensure that patients are restrained only temporarily, with their consent and when there is no safe alternative.

Experts agree that restraints are sometimes warranted: for example, wrist straps to keep a delirious patient who can't swallow from pulling out a feeding tube, or belts to keep a very frail person from falling out of a chair. But unless they are part of a care plan that balances the patient's safety and independence, restraints all too often become self-justifying. At a symposium in 1989 before the Senate Special Committee on Aging, Jill Blakeslee described the vicious circle.

"Why do we use these devices? The reason most often given is that we want to protect people from falling or eloping from the facility," said Blakeslee, director of health services at Kendal Corp., whose Kendal-Crosslands care community in Kennett Square, Pa., has had a policy of not using physical restraints since it opened in 1973.

But the patient, often under emotional stress, may become anxious and afraid, then resistant and angry, Blakeslee said. Care givers, seeing this, may be convinced that further restraint is necessary. Eventually, the patient becomes more withdrawn and immobile.

"We have little official data to prove or disprove that restraints prevent injury," Blakeslee said, "but we do know that restraints cause gross physical deterioration. The physical inactivity resulting from being tied to a bed or a chair causes minerals to drain from their bones, muscles to become weak and nonfunctioning, bladders to overflow and become sluggish and infected, appetites to decline, intestinal activity to slow and constipation to become chronic, and bed sores to propagate."

Kendal-Crosslands has been a model for the growing national "Untie the Elderly" movement. At least 38 such facilities now have no-restraint policies, said Beryl Goldman, Kendal's associate director for health services.

Nursing homes in New Hampshire, picking up on the motto that adorns vehicle license plates in that state, call their anti-restraint campaign "Live Free Or Die." In Vermont, a similar campaign is dubbed "Free the Elderly."

The issue of physical and chemical restraints, social worker Williams said, is "a key to unlock the bad box we've been in" with nursing homes "and to open up the door to a whole new approach, where a person is viewed as someone with life to live."

For too long, she said, nursing homes -- their furnishings, their schedules, their regimentation -- were too closely modeled on the acute-care hospital, "without enough thought about what it's like to live this way indefinitely."

For nursing home residents, she noted, "this isn't a week's stay in the hospital. It isn't as if you're going to leave. This is your life."