How do you stop someone with dementia from getting out of bed safely?

According to the Alzheimer's Association, six in ten people with dementia will wander at least once, and this often occurs at night, including getting out of bed. Knowing how to stop someone with dementia from getting out of bed safely is crucial for preventing falls and managing nighttime restlessness without resorting to restrictive measures.

Quick Summary

Managing a person with dementia getting out of bed requires identifying the root cause, creating a safe sleep environment, and using non-restrictive methods like bed alarms, sensor mats, and proper sleep hygiene to protect their well-being and prevent injury.

Key Points

• Identify Triggers: Pay close attention to potential reasons a person with dementia gets out of bed, including sundowning, unmet needs like hunger or a full bladder, pain, or confusion, and address them first.

• Enhance Bedroom Safety: Modify the bedroom environment by lowering the bed, placing protective floor mats, and removing tripping hazards to minimize injury risk during nighttime exits.

• Establish Routines: A consistent daily schedule with plenty of daytime activity and light exposure can help regulate the sleep-wake cycle and reduce nighttime restlessness associated with sundowning.

• Use Non-Restrictive Technology: Employ modern safety devices like weight-sensitive bed or floor alarms, door motion sensors, and wearable GPS trackers instead of dangerous physical restraints like bed rails.

• Prioritize Comfort and Security: Focus on creating a calming, familiar environment and meeting basic needs to reduce agitation. Avoid arguing or correcting the person, instead using gentle reassurance and redirection.

• Avoid Physical Restraints: Refrain from using bed rails or other physical restraints, which are often unsafe and have been shown to increase agitation, confusion, and the risk of serious injury from falls.

Understanding the Reasons for Getting Out of Bed

To effectively manage a person with dementia who frequently tries to get out of bed, it is vital to understand the underlying causes of their behavior. The reasons are often not malicious or deliberate, but rather a reflection of their impaired cognitive function.

• Sundowning: This is a common phenomenon where confusion and agitation worsen in the late afternoon and evening, potentially leading to a desire to wander or get up.
• Disorientation: A person with dementia may wake up and not recognize their surroundings, feeling confused or lost. Their instinct is to get out of bed to find something or to go somewhere more familiar.
• Unmet Needs: Simple needs can trigger restlessness. They may need to use the bathroom, feel hungry or thirsty, be in pain, or be bored.
• Following Past Routines: The person may believe it is time to go to work or complete another previous daily routine, prompting them to get out of bed.
• Restlessness and Insomnia: Disrupted sleep patterns are common in dementia, leading to wakefulness and a need to move around.
• Medication Side Effects: Certain medications can affect sleep cycles and increase agitation or confusion. A medication review with a healthcare provider may be necessary.

Creating a Safe Bedroom Environment

Modifying the bedroom can significantly reduce the risk of injury when the person does get out of bed. Focus on making the environment safe and reassuring, rather than physically restrictive.

• Lower the Bed: Lowering the bed to be closer to the floor reduces the risk of serious injury from a fall. Specialty "low beds" are also an option.
• Use Floor Mats: Place thick, padded mats or cushioning on the floor next to the bed to soften a potential fall.
• Clear Clutter: Remove any unnecessary furniture, electrical cords, or throw rugs from the room to eliminate tripping hazards.
• Provide Adequate Lighting: Install nightlights with motion sensors to automatically light the way for trips to the bathroom. Good lighting can reduce shadows that might cause confusion.
• Eliminate Restraints: Physical and environmental restraints, including bed rails, can be dangerous for people with dementia. They can cause feelings of fear and dehumanization, and patients may try to climb over them, leading to more serious falls. The FDA has issued safety warnings about bed rails due to the risk of entrapment.

Behavioral and Routine-Based Strategies

Establishing a consistent routine and using behavioral techniques can be highly effective in managing restlessness and agitation that leads to getting out of bed.

• Maintain a Consistent Daily Routine: A predictable schedule for meals, activities, and bedtime provides a sense of stability and reduces confusion.
• Promote Daytime Activity: Encourage physical activity and exposure to natural sunlight during the day. This helps regulate the sleep-wake cycle and can improve nighttime sleep.
• Limit Daytime Naps: If possible, limit or eliminate long afternoon naps to promote better sleep at night.
• Create a Calming Bedtime Routine: Establish a relaxing ritual before bed, such as listening to soft music, reading a book, or a gentle massage.
• Limit Caffeine and Sugar: Avoid serving caffeinated beverages and sugary snacks in the evening.
• Address Basic Needs: Ensure all physical needs are met before bed. A trip to the bathroom, a light snack, or a glass of water can prevent restlessness.
• Avoid Overstimulation: In the late afternoon and evening, minimize loud noises, excessive visitors, and overstimulating activities that can worsen sundowning.

Technological and Product Solutions

Several technologies and specialized products are available to assist caregivers in keeping a person with dementia safe at night.

• Bed and Chair Alarms: Weight-sensitive pads placed under the mattress or on a chair can alert a caregiver when the person gets up.
• Motion Sensors: Sensors can be placed at the bedroom or home exit door to chime when movement is detected, alerting the caregiver.
• GPS Trackers: Wearable GPS devices can help locate a person who has wandered away from home.
• Visual Barriers: Placing a dark-colored mat or painting a dark stripe in front of the bedroom or exit door can act as a visual barrier, as some individuals with dementia may interpret it as a hole they cannot cross.

Comparison of Bed Safety Devices

Feature	Weight-Sensing Bed Pad	Wireless Floor Mat	Wearable GPS Tracker
Mechanism	Pressure-sensitive pad under mattress or sheet.	Pressure-sensitive mat placed on the floor.	GPS technology in a bracelet, watch, or pendant.
Alert Type	Signals a caregiver's monitor when pressure is removed.	Alerts a caregiver's monitor when pressure is applied.	Sends location data to a smartphone app.
Use Case	Ideal for alerting when a person sits up or gets out of bed.	Good for use near the bed or at a doorway to alert when a person begins to walk.	Best for tracking a person who wanders outside the home.
Pros	Non-intrusive, can be used covertly, reliable.	Highly reliable, easy to move, can be placed at doorways.	High-tech solution for tracking outside the home, provides peace of-mind for elopement risk.
Cons	Not useful if the person sits on the edge of the bed for a while, can be triggered by pets.	Can be a tripping hazard, may not be discreet.	Can be removed by the person, relies on battery life.

Conclusion: Prioritizing Compassion and Safety

Managing a person with dementia who tries to get out of bed is a complex challenge that requires a multi-faceted and compassionate approach. Physical restraints are not a safe or ethical solution and can increase both physical and emotional harm. The most effective strategies involve understanding the underlying triggers for the behavior, creating a secure and comfortable environment, and implementing routines that support a calm and predictable daily life. By combining these methods with modern, non-restrictive technologies, caregivers can protect their loved one's safety while preserving their dignity and well-being. For more information on managing dementia behaviors, the Alzheimer's Association is a valuable resource offering support and expert advice.

Frequently Asked Questions

Are bed rails safe for a person with dementia?

No, bed rails are not recommended for people with dementia. They can pose a serious entrapment risk and may cause the individual to try climbing over them, leading to a more dangerous fall.

What is sundowning and how does it relate to getting out of bed?

Sundowning is a state of increased confusion and agitation that can occur in the late afternoon and evening in people with dementia. It can make them more restless and likely to get out of bed to wander or pace.

How can a caregiver manage sundowning to prevent a person from getting out of bed?

To manage sundowning, maintain a predictable daily routine, increase daytime light exposure and activity, and create a calm, low-stimulation environment in the evening.

Are bed alarms an effective way to stop someone with dementia from getting out of bed?

Bed alarms don't 'stop' the person, but they are an effective tool for safety. They immediately alert a caregiver when the person is rising, allowing for a timely response to assist them and prevent a fall.

What if the person is trying to get out of bed to 'go home'?

A person with dementia may get out of bed looking for a previous home or family member. Instead of correcting them, validate their feelings and gently redirect their attention to a comforting activity or familiar object.

What kind of home modifications can improve nighttime safety?

Modifications include lowering the bed, placing floor mats next to the bed, clearing clutter from walkways, and installing motion-activated nightlights to illuminate paths to the bathroom.

Could a medical issue be causing them to get out of bed?

Yes, an unmet medical need such as pain, discomfort, or a urinary tract infection could cause restlessness. It is important to rule out any underlying health problems with a doctor.