How to keep elderly from falling out of a wheelchair?

According to the CDC, falls are the leading cause of injury-related deaths among adults aged 65 or older. Learning how to keep elderly from falling out of a wheelchair is a critical aspect of fall prevention that can significantly improve safety, comfort, and confidence for both the user and their caregiver.

Quick Summary

Ensuring an elderly person stays safely in their wheelchair requires a multi-faceted approach, including proper posture support, using appropriate safety accessories, ensuring the wheelchair fits correctly, and practicing safe transfer techniques to prevent accidents.

Key Points

• Proper Seating Posture: Utilize wedge cushions or lateral supports to correct posture and prevent sliding forward or sideways.

• Smart Accessory Use: Integrate safety accessories like pelvic belts, anti-rollback brakes, and pressure-sensitive alarms for added security.

• Wheelchair Fit Matters: Ensure the wheelchair is correctly sized, with proper footrest and seat dimensions, to promote even weight distribution.

• Master Safe Transfers: Always lock brakes, use a gait belt, and position the chair correctly during transfers to minimize the risk of falls.

• Create a Hazard-Free Zone: Clear floors of clutter, eliminate uneven surfaces, and avoid overreaching for objects while seated.

• Consult a Professional: Work with an occupational therapist to assess individual needs and find the most appropriate and safest solutions.

Understanding the Risks of Wheelchair Falls

Falls from a wheelchair can have devastating consequences for elderly individuals, including fractures, head injuries, and a decline in overall health and independence. The reasons for these falls are varied and can be a combination of physical and environmental factors.

Common Causes for Falls

• Poor Posture and Weakness: Muscle weakness, especially in the core and upper body, can cause an individual to slump forward or sideways, leading to a fall. Neurological conditions like dementia or stroke can also affect a person's ability to maintain a stable sitting position.
• Incorrect Wheelchair Sizing: A wheelchair that is too wide offers inadequate lateral support, allowing the user to slide. Conversely, a chair that is too narrow can cause pressure points and discomfort, leading to the user shifting or attempting to stand improperly.
• Unsafe Transfers: Many falls occur during transfers from the wheelchair to another surface (bed, toilet, car). Improper technique, not using gait belts, and unlocked brakes are common mistakes that create significant risk.
• Environmental Hazards: Obstacles like cluttered floors, uneven surfaces, and loose rugs can impede wheelchair movement and increase the risk of tipping. Even reaching for an object that is too far away can cause the chair to destabilize.

Essential Wheelchair Safety Accessories

Equipping a wheelchair with the right safety accessories is one of the most effective ways to mitigate fall risks. These tools provide support, stability, and alerts for caregivers.

Cushions and Seating Support

• Wedge Cushions: A wedge cushion helps prevent forward sliding by creating a downward slope towards the back of the seat. For those who slide forward, a cushion with a pommel (an elevated section between the legs) can offer additional security.
• Lateral Supports: These are padded supports that attach to the sides of the wheelchair backrest to prevent the user from leaning or falling to the side. They are particularly useful for individuals with poor trunk control.

Belts and Harnesses

• Pelvic/Positioning Belts: A pelvic belt is crucial for stabilizing a person’s hips and pelvis. It should be positioned low and tight across the pelvis, not the abdomen, to prevent sliding. Crucially, these are not restraints but positioning aids, and the user must be able to remove it themselves for it not to be considered a restraint.
• Safety Harnesses: For individuals who may have difficulty with a simple belt, a more comprehensive harness can offer greater security by supporting the torso. It is vital to consult with a healthcare professional or an occupational therapist to ensure the harness is used correctly and does not function as an illegal restraint.

Anti-Rollback Devices and Alarms

• Anti-Rollback Brakes: These devices are a safeguard for seniors who forget to engage their wheel locks. They automatically prevent the chair from rolling backward, which is a common cause of falls during transfers or when attempting to stand.
• Pressure Alarms: A pressure-sensitive mat can be placed on the wheelchair seat. If the person begins to stand up or lean off the seat, the change in pressure will trigger an audible alarm, alerting the caregiver.

Optimizing Wheelchair Fit and Proper Use

Beyond accessories, ensuring the wheelchair itself is correctly configured is foundational to preventing falls. An occupational therapist can perform a thorough assessment.

Wheelchair Sizing and Adjustments

• Seat Width and Depth: The seat should be wide enough for comfort but narrow enough to provide side support. Seat depth should allow for even pressure distribution, with the user's knees at a 90-degree angle and feet flat on the footrests.
• Footrest Height: Correctly set footrests ensure the user's thighs are parallel to the seat, distributing weight evenly and preventing forward sliding caused by dangling feet or elevated knees.
• Tilt-in-Space Functionality: For those who spend long periods in their chair, a tilt-in-space feature can change the seat angle, shifting weight from the hips to the back. This is very effective at preventing sliding without changing the user's posture.

Practice Safe Transfers

1. Lock the Brakes: Always engage the wheel locks on the wheelchair and the transfer surface (bed, toilet) before any movement begins.
2. Use a Gait Belt: Properly apply a gait belt low around the user's waist for a secure grip during the transfer. Avoid grabbing the person's arms, which can cause injury.
3. Position Correctly: Position the wheelchair as close as possible to the destination surface. Transfer on the user's stronger side, if applicable.
4. Move Footrests: Swing the footrests out of the way to prevent them from becoming an obstacle during the transfer.

Comparison of Wheelchair Safety Solutions

Solution	Best For	Advantages	Considerations
Wedge Cushion	Preventing forward sliding for users with poor sitting posture.	Simple, non-invasive, affordable.	May not address severe instability.
Lateral Supports	Individuals with poor trunk control or those who lean to one side.	Provides excellent side-to-side stability and posture support.	Can feel restrictive; professional fitting is often needed.
Pelvic Belt	Stabilizing the pelvis to prevent sliding.	Effective for mild to moderate sliding issues; easily adjustable.	Must be used as a positioning aid, not a restraint; proper fit is crucial.
Anti-Rollback Brakes	Users who forget to engage manual brakes during transfers.	Provides a critical backup safety feature during transfers.	Only prevents backward rolling; does not address forward falls.
Pressure Alarm	Caregivers who need alerts when the user attempts to exit the chair.	Offers early warning to prevent a fall; non-invasive.	Can be triggered by minor shifts; may not be suitable for those with dementia who find alarms distressing.
Tilt-in-Space Wheelchair	Individuals with very poor posture control who spend long periods seated.	Redistributes pressure, is extremely effective at preventing sliding.	Expensive; can be bulky and heavier than standard wheelchairs.

Conclusion: A Holistic Approach to Wheelchair Safety

Ultimately, keeping an elderly person from falling out of a wheelchair involves more than a single product. It requires a comprehensive strategy that includes the right equipment, a correctly-fitted wheelchair, a safe environment, and proper caregiver training. By understanding the root causes of falls and implementing a combination of these preventative measures—from using seat positioning aids to ensuring safe transfer techniques—caregivers can create a safer, more stable environment for their loved ones. Consulting with occupational therapists is highly recommended to receive personalized guidance tailored to the individual's specific needs, ensuring the best possible outcome for safety and independence. For further information on broader fall prevention, a helpful resource can be found at the National Institute on Aging website.

Frequently Asked Questions

What is the best device to prevent an elderly person from sliding forward in a wheelchair?

A wedge cushion or a wheelchair cushion with a pommel is highly effective for preventing forward sliding. These cushions create a slight incline toward the back of the chair, keeping the user securely in place.

Can I use a seatbelt to keep an elderly person from falling out of a wheelchair?

A lap belt or positioning belt can be used, but it's important to use it correctly as a positioning aid, not a restraint. The individual should be able to unfasten it themselves. Always place it low and securely over the pelvis, not the stomach.

Are there wheelchair alarms to alert caregivers if a senior is trying to get up?

Yes, pressure-sensitive alarms are available. These devices consist of a mat placed on the seat that triggers an alarm when the user’s weight is removed, alerting caregivers that the person is attempting to exit the chair.

How do I know if the wheelchair is the right size for an elderly person?

An occupational therapist can perform a professional fitting. Signs of an improper fit include the user sliding forward, leaning to one side, or having their feet dangling or knees elevated when seated.

What is a tilt-in-space wheelchair and how does it prevent falls?

A tilt-in-space wheelchair allows the seat and backrest to tilt backward together as a single unit. This feature shifts the user's weight backward, effectively preventing them from sliding forward and reducing pressure on the hips and spine.

What is the most common cause of falls from a wheelchair?

One of the most common causes is improper transfers. Forgetting to lock the wheelchair brakes, incorrect lifting techniques, and an unsteady user attempting to transfer without assistance are frequent culprits.

What should I do if an elderly person starts to fall during a transfer?

Instead of trying to stop the fall, which can injure both you and the senior, focus on lowering them safely to the nearest surface or to the floor. Use a gait belt to maintain control, bend your knees, and protect your back.