This article provides an historic and current overview of physical restraint use with emphasis on elderly patients in the critical care setting. The primary recipients of restraint application in American health care institutions today are older adults who are at risk for falls or who demonstrate disturbing behaviors, such as interference with medical treatments, agitation, or confusion. This article reviews the current literature about the effectiveness of physical restraint for these problems and other situations that historically have justified the use of restraints in health care. Alternatives to physical restraints and guidelines for restraint use also are presented.