Falls are a primary safety concern for older adults, and incidents occurring during the night or when getting out of bed are frequent and dangerous. These incidents often result in serious injuries, such as hip fractures or head trauma, which can lead to a significant decline in independence. Understanding the physiological and environmental factors that contribute to these falls is the first step toward implementing effective safety measures. By examining a person’s health profile and the immediate sleeping environment, many nighttime falls can be successfully prevented.
Internal Health Factors Contributing to Falls
Certain medications affect the central nervous system, creating an elevated risk for falls, especially during nighttime hours. Hypnotics, sedatives, and anti-anxiety drugs may cause grogginess or disorientation upon waking, while certain antidepressants can impair balance and coordination. Blood pressure medications, such as diuretics or antihypertensives, can lead to orthostatic hypotension, where blood pressure drops suddenly when standing up, causing dizziness and faintness.
Neurological conditions directly impact the motor control necessary for safe transfers. Conditions like Parkinson’s disease or the after-effects of a stroke can cause muscle rigidity, poor balance, and a reduced ability to initiate movement smoothly. Cognitive impairments, including dementia and delirium from acute illnesses like a urinary tract infection (UTI), can lead to confusion, causing an individual to attempt to get out of bed without calling for assistance.
Underlying sleep disturbances also increase the risk of falling out of bed. Individuals with restless legs syndrome or rapid eye movement (REM) sleep behavior disorder may experience sudden, uncontrolled movements or physically act out dreams, causing them to roll off the mattress. Frequent nocturnal awakenings, often due to the need to urinate, force a person to navigate a dark room while still in a state of incomplete wakefulness.
Environmental and Situational Triggers
The physical setup of the bedroom can present immediate hazards. A bed’s height is a significant factor; if it is too high, it increases the distance of a potential fall and makes a controlled transfer difficult. Conversely, a bed that is too low requires greater leg strength and range of motion to push up to a standing position, which can strain mobility-impaired joints.
The mattress itself contributes to stability. Overly soft or unsupportive materials can create a sinking feeling that makes turning or sitting up challenging. Strong edge support is necessary, as a flimsy perimeter offers no secure base for sitting before standing, increasing the likelihood of sliding off. Clutter, such as throw rugs or electrical cords near the bed, creates tripping hazards in the dim light of the nighttime environment.
Poor lighting conditions are a major situational trigger, especially on the path between the bed and the bathroom. Moving in the middle of the night makes it nearly impossible to see obstacles or judge distances accurately. Furthermore, placing necessities like a phone, water, or a call button too far away may prompt a person to lean, reach, or get out of bed without proper support.
Proactive Safety and Prevention Measures
Mitigating fall risk involves reviewing a person’s medication regimen with a healthcare provider, targeting drugs that induce drowsiness or dizziness. A pharmacist or physician can evaluate if a lower dose is appropriate or if alternative medications with fewer central nervous system side effects are available. This review should address polypharmacy, which is the use of multiple medications that can cause adverse drug interactions that increase instability.
Physical and occupational therapy assessments provide hands-on training for safe transfer techniques, such as the “nose over toes” movement for standing up. Occupational therapists recommend home modifications and adaptive equipment, ensuring the person maintains independence while minimizing risk. This includes setting the bed height so the person’s feet are flat on the floor and their hips are slightly higher than their knees when seated at the edge.
Implementing specific equipment can transform the sleeping environment into a safer space for high-risk individuals.
Equipment and Environmental Adjustments
- Floor-level beds, which can be lowered to under four inches off the ground, significantly reduce the severity of injury if a fall occurs.
- Bed alarms sense pressure removal from the mattress and immediately alert a caregiver when a person attempts to exit the bed unassisted.
- Placing bedside fall mats with beveled edges next to the bed can absorb the impact of an unexpected fall, minimizing the chance of fracture or head injury.
- Scheduled toileting programs interrupt the sleep-wake cycle at predetermined intervals, proactively addressing the need to use the bathroom before urgency causes an unsafe exit from bed.
- Motion-sensor nightlights along the path to the bathroom provide low-level illumination without requiring a person to search for a switch.