Are Bed Rails a Last Resort for Someone Who Is at Risk of Falling Out of Bed?

According to the CDC, over 36 million falls are reported among older adults each year, many occurring in the home. This alarming statistic brings to light the critical question: Are bed rails a last resort for someone who is at risk of falling out of bed? The answer is more complex than a simple yes or no, involving a comprehensive evaluation of both risk and benefit.

Quick Summary

Bed rails are not automatically a last resort but should be considered carefully after a thorough assessment of an individual's needs and risks. High-risk factors like cognitive impairment or confusion often make bed rails unsuitable, necessitating a primary focus on less restrictive alternatives, such as lower beds or floor mats, to prevent falls and entrapment.

Key Points

• Assessment is Key: Before using bed rails, a thorough, individualized assessment of the senior's mobility, cognition, and specific risks is essential to avoid potential harm.

• Significant Entrapment Risk: Traditional bed rails can create dangerous gaps, posing a serious risk of entrapment, injury, or asphyxiation, especially for cognitively impaired individuals.

• Falls Can Be Worse: Seniors with confusion or dementia may attempt to climb over rails, leading to a fall from a greater height and more severe injury than an unassisted fall from a low bed.

• Alternatives are Often Safer: Safer, less restrictive options like lowering the bed, using floor mats, bed alarms, or bed canes are often more effective for preventing injury.

• Proper Use is Mandatory: If bed rails are deemed appropriate, they must be correctly installed, compatible with the mattress, and regularly inspected to eliminate entrapment hazards.

• Not a Substitute for Monitoring: Bed rails should never replace proper supervision, particularly for those at high risk of falls.

Understanding the Complex Role of Bed Rails

Once a standard fixture in caregiving, bed rails have undergone significant scrutiny over the last few decades. The perception of bed rails as a straightforward safety measure has shifted dramatically as experts have recognized the serious risks they can pose, particularly for certain individuals. While they may seem like a simple solution to prevent someone from falling out of bed, they are no longer viewed as a universal remedy. Instead, they are considered a tool that requires a careful and individualized assessment to determine if the benefits outweigh the dangers for a specific person. The decision to use bed rails should never be taken lightly or adopted as the default choice.

The Significant Risks Associated with Bed Rail Use

Using bed rails, especially full-length ones, is not without serious hazards. The Food and Drug Administration (FDA) and other health organizations have documented numerous injuries and fatalities related to bed rail misuse.

Entrapment

This is one of the most serious and well-documented risks. A person can become trapped in one of the seven zones of entrapment, such as between the mattress and the rail, between the bars of the rail, or between the rail and the headboard/footboard. Entrapment can lead to serious injury or asphyxiation, especially for those who are frail, restless, or have cognitive impairments like Alzheimer's or dementia.

Falls from Climbing

For individuals with cognitive issues, bed rails can trigger a feeling of confinement or panic. Instead of staying safely in bed, they may attempt to climb over the rails to escape. A fall from this elevated position is often far more serious than a fall from a lower bed, leading to fractures, head injuries, or death.

Psychological Impact

Bed rails can create a sense of institutionalization and restrict a person's independence. This can lead to increased anxiety, fear, and distress, particularly for those who already feel a loss of control over their lives. The psychological toll can negatively impact a senior’s overall well-being.

Safer Alternatives to Consider

For many at-risk individuals, alternatives to traditional bed rails offer a safer and more person-centered approach to fall prevention. These solutions prioritize safety while maintaining dignity and mobility.

1. Lower Bed Height: An adjustable height bed can be lowered so that the mattress is just a few inches from the floor, drastically reducing the distance and impact of a fall. Keeping the bed in its lowest position is a key practice.
2. Bed Alarms and Monitoring Systems: Pressure-sensitive pads placed on the bed or beside it can alert a caregiver when a person attempts to get up, allowing for timely assistance. This provides monitoring without physical restriction.
3. Floor Mats: Placing cushioned floor mats next to the bed can soften the impact of an accidental fall. These are particularly effective when combined with a low bed.
4. Bed Canes or Assist Bars: These devices are smaller than traditional bed rails and function as grab bars, providing a sturdy handle for a person to use when repositioning or getting in and out of bed. They don’t create a full barrier and are generally safer.
5. Concave Mattresses or Roll Guards: Mattresses with raised foam edges or foam bumpers can help prevent a person from rolling out of bed without creating the entrapment risk of a traditional bed rail.
6. Improved Lighting and Environment: Simple environmental modifications, such as installing night-lights or motion-activated lights, can significantly reduce nighttime falls.

Comparing Bed Rails and Alternatives

To make an informed decision, it's essential to weigh the specific characteristics of bed rails against other options.

Feature	Bed Rails	Safer Alternatives (Low Bed, Mats, etc.)
Effectiveness	Can prevent rolling out, but can increase severity of falls from climbing over.	Directly addresses the risk of fall impact; improves safe transfers and mobility.
Entrapment Risk	High, especially with ill-fitting rails or cognitive impairment.	Negligible to none.
Impact on Independence	Can limit independence and foster a sense of confinement.	Promotes independence by providing assistance without confinement.
Cognitive Safety	Dangerous for those with dementia or confusion who may try to climb over.	Generally safer, as they don't trigger the same panic or escape attempts.
Installation/Setup	Requires careful installation and compatibility checks with mattress and frame.	Often simpler; low beds can be adjusted, mats just need to be placed.

Best Practices for Using Bed Rails Safely

If a comprehensive assessment determines that a bed rail is the safest option for a particular individual, strict safety protocols must be followed.

• Proper Assessment: A physician's order and a documented assessment of the resident's physical and mental status should be completed before use. Use should be re-evaluated on an ongoing basis.
• Correct Installation: Rails must be installed according to the manufacturer’s instructions and secured properly to the bed frame to prevent shifting or loosening over time.
• Compatibility: Ensure the bed rail is compatible with the specific bed frame and mattress to eliminate dangerous gaps that could cause entrapment.
• Regular Inspection: Regularly check the rail and its attachment points for wear, damage, and continued secure fit.
• Continuous Monitoring: Bed rails are not a substitute for proper monitoring, especially for high-risk individuals. Caregivers must remain vigilant.

Conclusion: A Person-Centered Approach

Ultimately, the idea of bed rails being a 'last resort' for fall prevention is a necessary perspective shift. They should not be the automatic first, second, or even third choice. Instead, they are one tool among many, reserved for specific situations where a full assessment confirms the benefits for an alert individual needing transfer support outweigh the inherent risks. For those with cognitive impairment, confusion, or a history of climbing, less restrictive alternatives are almost always the safer and more compassionate choice. A person-centered approach, involving a thorough risk evaluation, consideration of multiple strategies, and clear communication, is the most effective path to creating a truly safe sleeping environment for seniors at risk of falling. For more detailed safety guidelines, refer to the FDA Recommendations for Adult Portable Bed Rails.

Frequently Asked Questions

Are bed rails a form of restraint for seniors?

Yes, depending on the circumstances, bed rails can be considered a form of physical restraint if they prevent a person from getting out of bed freely. This is especially true for individuals with cognitive impairment who may perceive them as a barrier, causing distress and potential injury as they try to climb over them.

What are the first steps to take when a senior is at risk of falling out of bed?

The first step is a comprehensive assessment by a healthcare provider. This should identify the root causes of the fall risk, such as medication side effects, balance issues, or confusion. Implementing non-restrictive solutions like a low bed or floor mats should be the initial focus.

Can bed rails cause death?

Yes, tragically, bed rails have been associated with fatal injuries. Entrapment and asphyxiation in the gaps between the mattress and the rail have been reported, as have fatal falls that occur when a person attempts to climb over the rail.

Are half-length bed rails safer than full-length bed rails?

Half-length rails are often considered a safer alternative because they provide support for transfers while leaving an opening for the senior to exit the bed independently. However, they must still be properly fitted to avoid entrapment zones and are not suitable for all individuals.

How can caregivers determine if bed rails are the right choice?

Caregivers should involve a healthcare professional in a person-centered assessment. Key factors to consider include the senior's mobility level, cognitive function, and history of climbing or restlessness. The senior's preferences should also be taken into account.

What are some low-cost alternatives to bed rails?

Low-cost alternatives include using foam bumpers or wedges under the fitted sheet to create a barrier, placing thick floor mats or crash pads next to the bed, and using motion-activated night-lights to improve visibility during nighttime trips to the bathroom. Some beds can also be manually lowered closer to the floor.

Is it true that bed rails don't actually prevent falls?

Studies have shown that while bed rails can reduce the risk of a fall by 10-15%, they can increase the risk of injury by 20% due to factors like entrapment and falls from a greater height. This indicates they are not a guaranteed fall prevention tool and can introduce new, significant risks.