How to Keep an Elderly Patient from Sliding Down in Bed?

According to a 1995 study, nurses in one hospital repositioned patients who slid down in bed nearly 10 times per shift, a task that carries a high risk of caregiver injury. Learning how to keep an elderly patient from sliding down in bed is essential for both their safety and the caregiver's well-being, as it prevents skin shearing, pressure ulcers, and fall risks.

Quick Summary

This guide offers practical solutions to prevent an elderly patient from sliding down in bed, including proper positioning, using specialized equipment, and maintaining the correct bed angle. Addressing these factors helps minimize the risk of skin damage and patient discomfort.

Key Points

• Elevate the Knees: Adjusting the knee section of an adjustable bed helps create a cradle that prevents the patient from sliding towards the foot of the bed.

• Maintain a Low Head-of-Bed Angle: Keeping the head of the bed below 30 degrees for bedridden patients minimizes shearing forces that can cause pressure ulcers.

• Utilize a Draw Sheet: Using a friction-reducing or draw sheet allows caregivers to reposition a patient safely and easily, preventing skin shearing and caregiver back strain.

• Use Anti-Slip Products: Non-slip mattress pads, specialized linens, or foam wedges can increase friction and provide physical barriers to prevent downward migration.

• Avoid Slippery Linens: Be mindful that overusing or improperly placing slippery incontinence pads can exacerbate the sliding problem.

• Consider Specialized Beds: Advanced hospital beds with features like automatic Fowler adjustment can actively prevent a patient from sinking and sliding as the bed is articulated.

• Use Pillows for Support: Strategically placed pillows or foam wedges can support the patient in a side-lying position and float the heels to prevent pressure injuries.

Understanding Why Patients Slide Down in Bed

Patient migration, or sliding down in bed, is a common issue caused by gravity, especially when the head of a hospital or adjustable bed is elevated. This downward movement creates shearing forces, which are particularly damaging to fragile elderly skin over bony prominences like the tailbone. Repetitive sliding and pulling a patient back up can worsen skin shearing, increasing the risk of painful and potentially life-threatening pressure ulcers. Additionally, it can lead to caregiver back injuries from improper lifting. A combination of factors, including bed angle, mattress type, and linens, often contributes to the problem, so a multi-pronged approach is most effective.

Proper Positioning and Techniques

Implementing proper positioning is the first line of defense against sliding and skin shearing. For patients who can assist, encouraging them to participate in repositioning is helpful.

• Elevate the knees: When raising the head of the bed, a critical step is to also raise the knee section. This creates a 'cradle' effect that prevents the patient from sliding towards the footboard. The patient's bottom should be positioned as close to the raised knee area as possible.
• Maintain a safe head-of-bed angle: For bedridden patients at risk of pressure ulcers, the head of the bed should not be elevated more than 30 degrees. This reduces shearing forces on the buttocks. However, for patients eating or with breathing difficulties, a higher angle (Fowler's position) may be necessary, and additional anti-sliding measures should be taken.
• Use a draw sheet: A friction-reducing sheet, or draw sheet, is essential for safely repositioning a patient up toward the head of the bed. It allows multiple caregivers to slide the patient without causing harmful friction or shearing on their skin. Caregivers should use proper body mechanics and avoid manual pulling to prevent back injury.
• Float the heels: To prevent pressure ulcers on the heels, place a pillow under the calves to elevate the heels off the mattress.

Choosing the Right Equipment

Using specialized equipment can significantly reduce the frequency of sliding and the effort required for repositioning.

Anti-Slip Linens and Pads

• Non-slip bed linens: Some linens are designed with non-slip backings or silicone coatings that increase friction with the mattress surface, helping to keep sheets and the patient in place.
• Avoid slippery incontinence pads: Improper use or stacking of multiple incontinence pads can create a slippery surface, increasing the risk of sliding. Ensure they are used correctly and a single layer is sufficient.
• Low-shear mattress covers: Consider a mattress cover made from low-shear, low-friction material to reduce the grab on the patient's skin and decrease the risk of injury.

Positional Aids

• Foam wedges: These can be used to support a patient on their side, preventing them from rolling back into a supine position and redistributing pressure. A wedge can also be placed under the mattress to create a slight angle that keeps the patient from sliding.
• Mattress retainers and bolsters: Specialized products like mattress retainers, footboards, or mattress overlays with raised foam edges can provide a physical barrier to prevent sliding. For adjustable beds, retainer bars can be installed at the foot.
• Air-assisted devices: For heavier patients or those needing frequent repositioning, an air-assisted transfer or positioning device can make moving the patient easier and safer. These devices inflate to lift and move the patient with minimal friction.

Medical Equipment Comparison: Manual vs. Specialized Aid

Choosing the right equipment depends on the patient's specific needs, mobility level, and risk factors. Here is a comparison of manual vs. specialized aid approaches to preventing sliding.

Feature	Manual Repositioning (with draw sheet)	Specialized Equipment (e.g., air mattress, foam wedges)
Effectiveness	Requires frequent intervention, but can prevent sliding in the short term.	Provides continuous support and addresses underlying issues of pressure and shear.
Effort Required	High physical effort for caregivers, which can lead to injury over time.	Low physical effort for caregivers once set up, reducing strain.
Cost	Low initial cost (for linens).	Higher initial investment for equipment.
Risk of Injury	High risk of skin shearing and pressure ulcers if performed improperly.	Low risk of skin shearing and pressure ulcers due to specialized design.
Patient Comfort	May provide temporary relief but requires frequent disturbance.	Promotes sustained comfort by maintaining proper alignment and support.
Best For	Patients with some mobility who can assist, or during temporary bed stays.	Immobile or high-risk patients, especially those spending long periods in bed.

The Role of the Bed Frame

If using a hospital or adjustable bed, the bed frame's function is critical. Some modern hospital beds feature technology to address sliding directly. For instance, an automatic Fowler function can adjust bladder pressures in the mattress as the head of the bed is raised, preventing the patient from sinking and shearing. Ensuring the bed frame itself is stable and properly assembled is also crucial to prevent any unexpected movement.

Conclusion

Keeping an elderly patient from sliding down in bed is a multi-faceted task that requires attention to proper positioning, using appropriate equipment, and understanding the causes. By correctly elevating the knees, using non-slip linens and positioning aids, and leveraging specialized beds or mattresses, caregivers can significantly reduce the risk of shearing, pressure ulcers, and caregiver back injuries. Always consult with a healthcare provider to ensure that the chosen strategies are suitable for the individual patient's medical condition and mobility level. Taking these proactive steps ensures the elderly patient remains safe, comfortable, and well-cared for, promoting better overall health and peace of mind for everyone involved.

This article provides general information and is not a substitute for professional medical advice. Always consult a healthcare professional for diagnosis and treatment.

Frequently Asked Questions

What is the primary cause of an elderly patient sliding down in bed?

The primary cause is gravity, especially when the head of an adjustable bed is raised. This causes the patient to migrate toward the foot of the bed, creating shearing forces on the skin, particularly over bony areas.

How can a draw sheet help prevent sliding and injury?

A draw sheet (a folded sheet placed under the patient) reduces friction, allowing caregivers to slide the patient up the bed rather than lift them. This prevents skin shearing and reduces the risk of back injury for the caregiver.

What is the recommended head-of-bed angle to prevent sliding?

For bedridden patients at high risk for pressure ulcers, keeping the head of the bed no higher than 30 degrees is recommended to minimize sliding and shearing forces. For higher angles, additional precautions must be taken.

Can an inflatable mattress help with patient migration?

Yes, some air-assisted or alternating pressure mattresses, especially those with an automatic Fowler function, can help prevent sinking and sliding by adjusting air pressures as the bed angle changes.

Are bed rails a good solution for preventing a patient from sliding?

While bed rails can provide a handhold and prevent falls, they are not a direct solution for preventing sliding down the bed. Relying solely on them can cause the patient to slide into gaps or worsen shearing. Proper positioning aids are more effective.

How can I reduce friction on the bed surface?

Using low-shear, low-friction mattress covers and being cautious with multiple layers of slippery linens or incontinence pads can help. A well-placed draw sheet can also effectively reduce friction.

What is skin shearing and why is it dangerous for the elderly?

Skin shearing is the tearing of skin layers caused by friction and pressure, which occurs when the skin moves one way and the underlying tissue moves another. For the elderly, whose skin is more fragile, it can lead to painful pressure ulcers and serious complications.