The elderly often have a multitude of health conditions that may impact their ability to safely get out of bed. This can range from physical ailments that make them weaker, result in poor balance and a lower ability to stand for any duration of time.
As well, cognitive impairments are common in the frailest of the elderly, which may affect their ability to make rational decisions and can lead to unsafe choices. For instance, some individuals with dementia may try to get out of bed on their own, not understanding that they may have a fall related to their poor physical capabilities.
For the elderly at high risk of falls with getting out of bed, it is important to minimize any unsupervised bed transfer attempts and put in place any transfer aids that may support them or any devices that may reduce fall incidents.
Assistive aids to prevent elderly falling from bed
These are some ways to prevent a senior from rolling out of bed and falling:
- Foam Bed Bumper – foam placed at the edge of the bed that helps keep a senior in a more central location within the bed.
This product is considered a passive safety tool in that it helps trigger one’s subconscious to the dangers of being near the edge of the bed. It basically acts as a small hill that gently pushes someone away from the bed’s side and more towards the centre.
The material is made from foam, which makes it easily collapsible, and will not offer much resistance or prevent someone from getting out of bed when they need to. Thus, the bed pads do not need to be removed from underneath the sheets during any bed transfers.
- Pool Noodle – can be put at the side of the bed to act as a small ridge that prevents a senior from rolling out of bed.
Similar to a bed bumper, a pool noodle offers the exact same type of support in guiding an elderly individual towards the centre of the bed. With this product, it can be more easily customizable to one’s individual needs and body size.
The pool noodles can be cut into varying lengths as needed to fit the bed’s mattress. Most people tend to cut cylindrical shaped noodles in half to produce a flat surface to sit onto the mattress to reduce its ability to roll or shift out of position.
Of course, more caution needs to be taken when using this method to keep a senior well positioned within bed. The reason for this is that this method depends on one’s ability to craft the item into a desired shape and how well it is secured in place during use as it can shift around.
- Pillows – used around the outer edges of the bed to act as a reminder for a senior to stay more within the centre.
Using extra pillows on the sides is another inexpensive way to help position a senior more centrally within the bed. While this can be easily done with pillows that one may already have, pillows can easily shift, reposition or fall off the bed themselves.
As well, pillows can bunch up and lead to uncomfortable pressure against one’s body. As a result, pillows may not be an ideal solution to prevent seniors from falling out of bed.
- Rearranging the bedroom – beds can be placed against the wall to minimize one avenue from which a fall can occur.
Lastly, there are several ways to reduce a seniors risk of falling from bed by rearranging the furniture and bedroom setup. For example, the bed can be relocated against a wall and secured in place to prevent a gap from forming between the bed and the adjacent wall.
This will eliminate one possible avenue from which a fall can occur. Some seniors may prefer this option as they can then rest against the side of the wall knowing that they are the furthest they can possibly be from the other edge where there is a drop to the floor.
Another option would be to have the bed relocated to another room, possibly closer to an available caregiver who could provide assistance any time a senior would wish to get out of bed. This will give the senior additional support, and grant the caregiver peace of mind knowing that they may be assisted at a moment’s notice. However, it is important to be mindful of any caregiver burnout that may result from the proximity and additional support needs.
Ways to reduce fall injuries from bed
One of the largest predictors of future falls is having a history of previous falls. For this reason, it is important to reduce the risk of sustaining any injuries during a fall, improve the ability to seek caregiver support and have access to timely emergency services. This can be achieved in several ways:
- Fall mat – placed on the floor beside the bed, this protective mat helps to cushion someone’s fall out of bed to minimize injuries.
While the mat itself is thin, it does have some give to it when being stepped on. As a result, for those with unsteady balance or a poor ability to walk, the fall mat should be moved out of the way before it is stepped on when transferring out of bed and walking away.
- Lowering the bed height – reducing the overall height of the bed reduces the momentum one can gather if they were to fall out of bed, thus reducing the risk of a fracture or other injury.
Depending on the setup of one’s bed frame, the legs may be removable to reduce the height of the bed. If that is not the case, some people consider whether to place the mattress on the floor itself when sleeping. This action may void the mattress warranty as some manufacturers state that the mattresses must rest on a box spring or frame specifically to avoid developing any deformities.
Alternatively, the use of another bed with a smaller mattress profile or bed frame height can be explored.
- Fall detection medical alert system – a wrist bracelet or neck pendant that detects if someone has had a fall and alerts caregivers or emergency services that assistance is required.
With the use of a personal medical alarm system, help is always one button press away. As well, many systems now incorporate an auto detect fall feature that calls assistance right away without any further action from its wearer if a fall has been detected.
The auto fall detection feature is useful for many seniors as some choose to stay on the floor for hours rather than:
- call their family for help
- attempt to get up on their own following a fall and may have further unwitnessed falls or
- may be rendered unconscious during a fall and unable to press the button to seek emergency help
- Hip protectors – padding undergarment that is positioned at one’s hips to reduce the risk of a hip fracture.
Hip fractures can contribute to permanent disabilities or death, so it is important to protect against these injuries. Hip protectors are usually used by those the elderly that are at highest risk of falls or have brittle bones related to osteoporosis or medical treatment side effects.
Hip protectors are used to absorb the impact of a fall and reduce the risk of bone fractures by redirecting force away from the hip. These garments are soft, thin, worn underneath one’s pants or pajamas, can be used with incontinence products and are machine washable.
That said, it may be uncomfortable to wear the protective padding if one prefers to sleep on their side as it may slightly elevate one’s hips away from the bed. As a result, compliance with this protective aid can be an issue for side sleepers.
Transfer devices that can make getting out of bed more safe for the elderly
Most of the transfer devices designed to help with bed transfers require that the elderly individual have good pushing or pulling ability in their upper body.
These are some of the transfer aids that can assist the elderly with getting out of bed:
- Floor to ceiling security pole – a metallic rod placed near the bedside that can be pulled on for support to get out of bed.
This pole is held in place between the floor and ceiling by tension and can be height adjusted for varying ceiling heights. When installed correctly, the security pole can bear someone’s weight as it is pulled on to slowly assist with getting out of bed or slowly lowering oneself into bed.
- Sit to stand assistive walker – an aluminum frame walker that has an additional grab handle that can be pushed on for support to get into standing and used as a mobility aid to ambulate.
This four point walker can be used for bed transfers as a transfer aid. The lower handles can be used to stand with greater ease by offloading some of the required strength away from one’s legs and into the upper body.
- Sit the stand cane – a walking cane that has an additional grab handle that is slightly lower and can be used during bed transfers for improved security.
This cane can be used for walking support, but also helps someone stand up from bed by pushing on the lower handle. The handle has a soft foam grip to ensure that the hand does not slip.
- Bed assist railing – a grab handle secured either to the bed frame or underneath the mattress that is typically used to help with transferring out of bed.
This partial railing can help someone reposition their body in bed, but can also be pulled on to get to the edge of the bed and then pushed on to help someone stand up. Using this assistive device requires that one have sufficient arm strength and grasping ability.
This is a simple device to use to get out of bed, however it may be considered a restraint in some situations and should never be used as a replacement for falls prevention and injury mitigation strategies. The railing must always be placed at the head of the bed and measures must be taken to reduce the risk of entrapment or entanglement in the device.
Restraining devices that should be carefully considered prior to using for falls prevention
- Bed railings – full railings are considered restraints that may contribute to further injury or danger.
When bed rails are used with patients that may have cognitive deficits or an affected ability to reason and understand, they may be considered restraints and dangerous. Partial bed railings can be used for support during bed transfers in some cases for the cognitively impaired, however full railings pose a danger as they form a barrier to leaving the bed.
As an example, someone may not understand the full bed railing is meant to keep them within the bed and can be moved aside if they want to get out of bed. As a result, some cognitively impaired elderly may attempt to climb over the railing in their attempts to get out of bed on their own. This action can contribute to getting their limbs tangled within the railing or lead to a fall from an even greater height.
Given these risks, many hospitals and care homes have adopted policies that forbid them from using railings on beds related to the many injuries and deaths that have been attributed to railings.
The use of full hospital bed railings should be made on a case by case basis only after an individual has been evaluated to ensure that the railing does not pose any restraint or endangers their lives. Generally, full railings are placed in the up position temporarily when porters are transporting a hospital bed from one location to another to prevent someone from falling out during the move.
- Bed Exit Monitoring System – a bed pressure sensor pad placed underneath the senior lying down in bed that triggers an audible alarm for nearby caregivers to come for support if a senior attempts to stand up on their own.
This device is typically used with the elderly who may not understand that getting out of bed can lead to a fall. These frail individuals may have impaired insight into their decision making abilities and often require an increased level of support or supervision.
Depending on how a bed exit monitoring system is used, it can be considered a restraint. If its primary purpose is to alert caregivers to always redirect someone back to their bed and keep them lying down, it may be considered a restraint.
This device has another disadvantage in that the noise it makes if the elderly individual stands up, may actually confuse them if they do not understand what the alarm means and may agitate them. This can be mitigated to some degree by adjusting the alert’s volume and having the receiver mounted in a different room.
Ultimately, the role and purpose of using this tool must be carefully examined for each individual person to establish when it should and should not be used.
Why are bed rails dangerous and should not be used to prevent seniors from falling out of bed?
An elderly individual’s arm, shoulder or other body part may get stuck or tangled in the railing and in some cases the rest of their body hangs over the edge of the bed. This entrapment risk can pose a serious safety hazard that may lead to injury or even death in some circumstances.
For this reason, many nursing homes can’t use bed rails as it is dangerous for its residents who may not understand that a bed rail should only be used for repositioning within bed and for bed transfers.