How an older adult can help when turning an older adult in bed

According to the National Pressure Injury Advisory Panel, frequent repositioning is crucial for preventing pressure injuries in bedridden patients. To make this process smoother and safer for everyone involved, it is important to know what an older adult can do to help when turning an older adult in bed. By engaging key muscles and coordinating with their caregiver, older adults can actively participate in their own mobility, maintaining a sense of independence and control.

Quick Summary

This guide provides practical strategies for older adults to assist with repositioning in bed, including using their arms and legs for leverage and coordinating with a caregiver. It outlines techniques for both back-to-side and side-lying turns, details essential communication tips, and recommends supportive equipment. The information helps reduce the physical strain on caregivers and promotes the patient's comfort and well-being.

Key Points

• Engage lower body muscles: Encourage the older adult to bend their knees and use their legs to push and provide momentum for the turn.

• Use upper body strength: If possible, have them push down on the bed with their hands or pull on a bed rail to assist with the rolling motion.

• Position limbs strategically: Ask them to cross their arms over their chest and, when turning to the side, place the top leg slightly ahead of the bottom leg to aid the roll.

• Communicate clearly: Inform the older adult of every step to build trust and allow them to anticipate and assist with the movement.

• Utilize bed aids: Assistive devices like bed rails or trapeze bars can provide a strong point of contact for the older adult to use their own strength.

• Combine patient effort with caregiver technique: The caregiver should still use proper body mechanics and, if necessary, a draw sheet to ensure a smooth, safe turn.

Essential techniques for active participation

Engaging the older adult in the turning process is beneficial for both the patient and the caregiver. For the patient, it helps maintain muscle strength and encourages a sense of agency. For the caregiver, it significantly reduces physical strain and lowers the risk of back injury. Communication is vital; always explain each step of the process so the person knows what to expect and can assist effectively.

Before the turn

• Explain the process: Before touching the person, clearly explain what you are going to do. For example, "I'm going to help you roll onto your side now. If you can, please bend your knees and use your arms to help." This clear communication helps foster trust and cooperation.
• Clear the area: Ensure the area around the bed is clear of any objects or wires that could interfere with the movement.
• Position the bed: If you have an adjustable bed, raise it to a comfortable working height to reduce caregiver back strain.

Assisting with the roll

From lying on the back to the side

• Bend knees: Ask the older adult to bend their knees so their feet are flat on the bed. This creates a leverage point and reduces friction, making the roll easier.
• Cross arms: Have them cross their arms over their chest. This keeps their arms safely positioned and prevents them from interfering with the turn.
• Push with arms: If they have enough upper body strength, instruct them to push down with their hands on the bed. This helps them initiate the rolling motion and provides additional momentum.
• Grasp the rail: If a bed rail is available, they can use it to help pull themselves over.

For moving up in bed

• Use legs and feet: With knees bent and feet flat, ask them to push with their feet to help shift their body upward.
• Pull with arms: Using a trapeze bar or bed rail, they can pull to move toward the head of the bed.

Techniques for caregivers when the older adult assists

Even with active patient participation, caregivers must use proper body mechanics to prevent injury. Combining the patient's efforts with the caregiver's safe technique makes the process highly effective.

The turn toward the caregiver

1. Position the older adult: After communicating the plan, ask the person to bend their knees and place their arms across their chest.
2. Caregiver stance: Stand facing the bed on the side you want to turn the person toward. Use a wide, balanced stance with one foot in front of the other and bend your knees.
3. Engage the patient: Guide the older adult to roll toward you, prompting them to use their bent knees and arms to push and pull.
4. Caregiver support: Place one hand on the person's hip and the other on their shoulder to gently guide their movement. Shift your body weight from your back leg to your front leg as you guide them.

The draw sheet method

Using a draw sheet—a sheet folded in half and placed across the bed under the person's hips and shoulders—can make turning a patient who has more limited mobility easier and safer.

1. Position the draw sheet: Roll the person to one side, tucking a half-folded sheet under them. Roll them back over the sheet and flatten it out.
2. The turn: Stand on the side of the bed you're turning toward. Grasp the draw sheet near the patient's shoulder and hip.
3. Use teamwork: On the count of three, pull the draw sheet toward you while the older adult assists by bending their knees and pushing. This combined effort reduces friction and strain.

Comparison of active vs. passive turning methods

Feature	Active Patient Participation	Passive Caregiver Turning
Effort required from caregiver	Significantly reduced due to patient assistance.	Higher, especially with a heavier or less mobile person.
Patient autonomy	Encouraged, as the patient is actively involved in their movement.	Limited; the patient is fully dependent on the caregiver.
Safety risk	Lower risk for caregiver back injury due to shared effort.	Higher risk of back strain and injury for the caregiver.
Momentum	Patient-generated momentum assists the rolling motion.	Caregiver must create all momentum, potentially involving more force.
Best for	Individuals who can follow instructions and retain some strength.	Patients who are unable to assist due to illness, pain, or limited mobility.
Required equipment	May involve assistive devices like bed rails or trapeze bars.	Often requires assistive devices such as a draw sheet to prevent skin tears and caregiver strain.

Conclusion

By actively participating in their own repositioning, older adults can help make the process safer and more comfortable for both themselves and their caregivers. Simple actions like bending their knees, using their arms for leverage, and communicating effectively can significantly reduce the physical demands of turning. This not only minimizes the risk of injury for caregivers but also promotes a patient's independence and comfort. Whether with simple verbal cues or the aid of a draw sheet, involving the older adult in bed mobility is a cornerstone of compassionate and practical caregiving.

Frequently Asked Questions

What is the most effective way for an older adult to help turn themselves in bed?

The most effective method is for the older adult to bend their knees and push with their feet while using their arms to provide additional leverage. This works in coordination with the caregiver's guidance to create a smoother, less strenuous roll.

How can an older adult assist with moving up in bed?

To move up in bed, the older adult can bend their knees with their feet flat on the mattress and push with their legs. If available, they can also use a trapeze bar or bed rails to pull themselves toward the head of the bed.

Why is it important to have an older adult participate in their own repositioning?

Patient participation promotes a sense of independence and helps maintain muscle strength and joint mobility. For the caregiver, it reduces the risk of back injuries associated with lifting and repositioning.

What should the older adult do with their arms and legs during a turn?

During a turn, the older adult should bend their knees and cross their arms over their chest. Bending the knees reduces friction, while crossing the arms keeps them out of the way.

What if the older adult is afraid to help with the turn?

If an older adult is fearful, maintain calm and clear communication, explaining the process and the benefits of their help. A reassuring and unhurried approach, along with the use of a draw sheet and supportive equipment, can help build trust.

What tools can help an older adult assist with turning?

Assistive devices like bed rails, a trapeze bar, and a draw sheet are all helpful. Bed rails provide a secure handhold, a trapeze bar allows the person to use their arm strength, and a draw sheet reduces friction.

Should the older adult's arm be tucked under them during a turn?

No, it's important to prevent the older adult from lying directly on their arm, as this can cause discomfort and nerve compression. Position the bottom arm straight out in front and use a pillow to support the upper arm.