The most effective way to keep an elderly person from falling out of bed is to combine several strategies: lowering the bed height, using physical barriers like foam bolsters or bed rails, reducing the need for nighttime trips to the bathroom, and reviewing medications that cause dizziness or sedation. No single fix works on its own, because falls happen for different reasons depending on the person. Here’s how to address each one.
Why Elderly People Fall Out of Bed
Falls out of bed rarely happen for one simple reason. The most common contributors include weakness in the lower body, balance and gait problems, vision loss, cognitive impairment, depression, and the use of certain medications. Many older adults also deal with nocturia, the need to urinate multiple times during the night. Those rushed, groggy trips to the bathroom in low light are a major source of nighttime falls.
Sleep disturbances compound the problem. Fragmented sleep leaves people disoriented when they wake, and conditions like REM sleep behavior disorder can cause sudden, involuntary movements. Arthritis pain may also cause restless repositioning that shifts someone toward the edge of the mattress without them realizing it.
Lower the Bed as Much as Possible
The single most impactful environmental change is reducing bed height. Geriatric nursing guidelines recommend keeping the top of the mattress at or below knee height, which is roughly 19.5 inches for women and 21.3 inches for men. At that height, a person’s feet reach the floor when they sit on the edge, making transfers steadier and reducing the distance of any fall.
Many standard hospital-style beds sit at 24 inches or higher from floor to mattress top. If your loved one uses an adjustable bed, make it a habit to lower it to its minimum position at night. Some facilities use ultra-low beds that can drop even further. For a home setting, switching to a low-profile bed frame or placing the mattress directly on the floor (with a non-slip pad underneath) achieves the same goal. If the bed does need to be higher during the day for easier transfers, lower it every evening before sleep.
Choosing Between Bed Rails and Foam Bolsters
Traditional metal bed rails are the most familiar barrier, but they come with a serious risk: entrapment. The Consumer Product Safety Commission has identified four zones on portable bed rails where a person’s head, neck, or chest can become wedged, particularly between the rail and the mattress or within gaps in the rail itself. People with dementia or those who move unpredictably in their sleep are at the highest risk. If you use bed rails, make sure they meet the current safety standard (ASTM F3186-17), which tests for entrapment resistance and structural integrity. Check that the rail is labeled for your specific bed and mattress thickness.
Foam bolsters are a softer, lower-risk alternative. These are dense foam wedges or rolls placed under the fitted sheet along the open side of the bed. They create a raised edge, typically 4 to 6 inches high, that’s enough to prevent someone from rolling off during sleep without creating entrapment gaps. They won’t stop a person who is actively climbing out of bed, but for someone who simply drifts toward the edge while sleeping, they work well and carry virtually no entrapment risk.
Half-length rails, which cover only the top portion of the bed near the pillow, offer a middle ground. They give your loved one something to grip when sitting up or rolling over, while leaving the lower half of the bed open for easy exit. This reduces entrapment zones compared to full-length rails.
Bed Exit Alarms and Sensors
If your loved one needs to get out of bed at night but tends to do so unsafely, a bed exit alarm can alert you or a caregiver in time to help. There are several types. Pressure-sensitive pads sit under the sheet or under the mattress and trigger an alarm when the person’s weight shifts off the sensor. These are the most common, but they can produce false alarms from normal repositioning.
Dual-sensor systems combine a pressure pad with infrared beam detectors mounted near the bed. The alarm only sounds when both the pressure change and the beam break happen together, which more reliably indicates an actual attempt to leave the bed. Research comparing the two found that dual-sensor systems had fewer false alarms and were marginally better at catching true bed exits.
For home use, simple wireless pressure pads are the most practical option. Place the sensor under the mattress at the edge where your loved one typically exits. Pair it with a caregiver pager or a smart home notification so you can respond quickly without needing to be in the same room.
Reduce Nighttime Bathroom Trips
Since nocturia is one of the most common reasons older adults get out of bed at night, reducing those trips directly lowers fall risk. A few behavioral changes can make a significant difference. Have your loved one avoid caffeine, alcohol, and fluids in the two to three hours before bedtime. Make sure they empty their bladder right before getting into bed.
If nighttime trips can’t be eliminated, make each one as safe as possible. Keep a clear, obstacle-free path between the bed and the bathroom. Use motion-activated nightlights along the route so they never walk in the dark. A bedside commode eliminates the walk entirely and is one of the most practical solutions for someone with mobility limitations.
Review Medications That Increase Fall Risk
Several common medication classes directly increase the chance of nighttime falls. Benzodiazepines and sleep aids like zolpidem and eszopiclone cause sedation and impair balance, and the risk goes up both with new prescriptions and long-term use. Antidepressants, particularly at higher doses or when combined with other sedating drugs, also raise fall risk through drowsiness and slowed reflexes. Opioid pain medications have similar effects, especially at stronger doses or when layered with other drugs.
These medications can cause orthostatic hypotension, a sudden drop in blood pressure when standing up from a lying position. That dizzy, lightheaded feeling when your loved one sits up in bed at 2 a.m. is often medication-related. Diuretics, sometimes called “water pills,” also contribute by both lowering blood pressure and increasing nighttime urination. If your loved one takes any of these, a medication review with their prescriber is one of the highest-impact steps you can take. In many cases, doses can be adjusted or alternatives found.
Strengthen Bed Mobility With Simple Exercises
An older person who can reposition themselves confidently in bed is less likely to end up in a precarious position at the edge. Two exercises are particularly useful and can be done in bed with caregiver assistance.
Heel slides build knee and hip strength. Your loved one lies on their back and slides one heel along the mattress toward their bottom, then back down. If they can’t do it independently, you can guide the leg through the motion. The body roll practices the side-to-side movement needed to reposition in bed and to sit up safely. Encourage them to bend their knees toward the direction they want to roll, using their own body weight as momentum. Aim for 5 to 10 repetitions per exercise, two to three sets. If it feels too hard, fewer reps still help.
These exercises also help prevent pressure sores in people who spend long periods in bed, so they serve double duty.
Set Up the Bedroom for Safety
Beyond the bed itself, the surrounding environment matters. Place a cushioned floor mat on the side of the bed where a fall is most likely. These mats, typically about three-quarters of an inch thick, won’t prevent a fall but can significantly reduce impact on a hard floor. Choose one with a non-slip bottom so it doesn’t slide when stepped on.
Remove loose rugs, electrical cords, and any clutter from the floor around the bed. If your loved one wears socks to bed, switch to non-slip socks with rubber grips on the sole. Keep a phone, glasses, and anything else they might reach for on a stable nightstand within easy arm’s reach, so they don’t lean or stretch over the edge of the bed.
Good lighting is critical. A motion-activated light near the bed that turns on when feet touch the floor gives your loved one immediate visibility without requiring them to fumble for a switch. This one change addresses the low-light disorientation that contributes to so many nighttime falls.