What helps older adults get in and out of bed more safely?

My grandmother refused to use a walking frame for two years. She refused point blank. Eventually she slipped getting out of bed and brought the bedside table down with her, and the lamp on top of that. Luckily no one was hurt.

Incidents of falls experienced by Grandma that had not caused harm would have gone unnoticed by her and her family over a number of months. As she continues to loose strength, the number of slips and falls would start to increase until a serious incident happens that has long lasting effects.

Why getting out of bed is riskier than it looks

A fall can occur while a person is walking between locations within their home. However, the majority of falls with older adults occur while they are rising from bed and then going to the bathroom in the middle of the night. There are many times during the day and night when an older adult gets out of bed. In the middle of the night it is usually in a very dark room. After waking from sleep a person is half asleep and their muscles are not as strong as they were before they went to sleep. In addition, the person is not as balanced or coordinated as they were before they went to sleep.

It may help to think of a person’s ability to move safely as being like a tightrope walker’s ability to cross a tightrope. Just as a tightrope walker would fall after crossing a tightrope dozens of times, a person with a variety of factors which affect their ability to move safely (such as muscle weakness, joint stiffness, the effects of medication, and low blood pressure on standing – orthostatic hypotension) would also fall after completing a number of movements that involve those factors which affect their ability to move safely. The number of such factors that affect a person, or the number of movements that a person completes, both increase the risk of a fall. The movement of getting in and out of bed is one that an older adult does every day, and thus can result in a large number of repetitions of a movement or set of movements that affect a person’s safety.

The bedroom is often the last area that people will give much consideration to in terms of safety. Yet, it is an area that people frequently traverse – more frequently than they go to the shower – and it is an area that people are more apt to be uncoordinated in as they are getting up in the middle of the night.

4. Bed height: the fix nobody thinks of first

The height of your bed – often something not even thought about – can have the biggest impact in terms of falls around the home. Most people don’t even realize that getting in and out of bed is probably the most repeated activity we do every day. So, transferring in and out of bed is something that we all do on a regular basis – and more often than not in the dark, after waking. So, your balance isn’t as good as it was when you were asleep, as you’ve been asleep for a while and your body has been still for a while.

Most bedrooms have bed bases at a height where when you are sitting on the edge of the mattress your feet are not on the floor. The knee is not at a right angle and this creates a lot of risk. A simple way to modify your bed to reduce falls is to change the height of the legs. Using a mattress topper or a bed raiser are examples of inexpensive solutions. In most cases it is not necessary to purchase an entirely new bed.

The vast majority of beds on the market can be used in such a way as to to aid mobility in people who have been affected by illness or injury. This is often achieved by the use of adjustable bed legs, a mattress topper or a bed raiser which can be specifically designed for this purpose. The changes that can be made to a home in order to aid mobility of its users are often so simple that they do not need to cost a lot of money.

What actually helps near the bed

In attempting to pull themselves up with something next to them, people often reach for their bedside tables, the head of their bed, or even their sleeping partner. None of these things are meant to hold any weight and are therefore unable to hold up a person. The person falls, and the bedside table or headboard comes crashing down on the wall where it was attached with screws perhaps years before.

Dedicated support options make a real difference:

• Grab handles or bed assist handles that slot between the mattress and base, giving a firm grip right where the person is pushing up from
• Bed rails that run along the side of the mattress, providing something to hold during both sitting up and transferring to standing
• A sturdy step stool with a handle, especially useful if the bed runs on the higher side
• A bed trapeze or overhead grab bar for people with significant upper body strength but limited lower body function

As already stated above, none of the equipment listed above is suitable for every individual. For example, a person recovering from a hip replacement may need completely different equipment to a person with Parkinson’s disease. Therefore, an assessment by an Occupational Therapist is worth every minute of time if possible.

The 2am problem

Getting up in the middle of the night to go to the bathroom is when most falls happen. Why? Because it is in the dark, and you are half asleep. So your body is in a sort of halfway state between being asleep and being awake. That means you are in a sort of halfway state between being fully relaxed and being fully alert. This is important because any sudden movement while you are in this sort of state will cause a sudden drop in blood pressure, which in turn causes dizziness or a loss of balance for a short time.

Nighttime bathroom trips also pose significant risk for falls. These incidents occur when a person is most at risk for falls, i.e., when their eyes are not fully adapted to the dark, they are between being fully awake and fully asleep, they are less able to balance due to weakness in their muscles and as a result of being less coordinated, and they stand up too quickly from a lying position. The result is that their blood pressure can drop very quickly, which can cause them to fall. There is an easy solution to these falls. Motion-activated night lights can be placed along the floor to direct the older adult to the bathroom. These are very inexpensive and can make a world of difference in protecting an older adult from falls when they are going to the bathroom at night.

See also: How Does Occupational Therapy Support Greater Independence at Home and in the Community?

Problem	Likely cause	Practical fix
Struggling to push up from sitting	Bed too low, weak arms or legs	Bed raisers, grab handle or rail
Feeling unsteady when standing	Orthostatic hypotension, balance issues	Sit at edge for 30 seconds before standing, side rail for support
Legs don’t reach the floor	Bed too high	Handled step stool, lower the bed base
Falls during night trips	Poor lighting, disorientation	Motion-sensor floor lights along the route

The part that actually matters most

Most of the writing about falls as an issue for older people focuses on fall prevention as a program or policy issue. In other words, it focuses on risk assessment, on statistics about falls and fallers, on the legal liabilities of carers and healthcare providers. All this is well and good. But for most people, being in their own home, in their own bedroom, for as long as possible is what matters. And that in turn means being able to get in and out of bed without help.

For most elderly people being able to safely get into and out of their beds is a matter of dignity. Having to get up in the middle of the night and have to call for help to get back to bed is degrading. Most people, as they get older, want to remain in their own homes, in their own beds, and be independent. They don’t want to be a burden to their family or to their caregivers.

My grandmother got the bed rail that she had always wanted. I helped her find the one that best fit her needs. I even went up in the attic to pull down the extra bed rails that had been stored up there for years. It wasn’t so much that the bed rail would prevent her from falling that mattered most to me, it mattered that she could get in and out of bed without needing help. It’s not so much that it helped her that matters most to me, it’s that she can stay in her home, her bedroom, on her terms. That matters most to her. That matters most to most people.

This can be a complex issue and it is likely that there is no one answer that will work for every individual. But to start with, ensuring that the bed is at the right height for the individual is an important starting point. Then, providing support rails or handles in the room can also be useful. Additionally, having good lighting in the room and having a plan of action that has been developed with the individual who requires to use the bed can also be very effective. So long as you are doing better than just waiting for the lamp to come down then you are likely doing ok.