What are the two main risks of using bed rails? A Comprehensive Guide

Despite being intended to protect older adults from falls, bed rails can inadvertently cause serious harm. The U.S. Food and Drug Administration (FDA) has received numerous reports of bed rail-related injuries and deaths, highlighting the critical question: What are the two main risks of using bed rails?

Quick Summary

The two primary risks of using bed rails are entrapment, which can cause asphyxiation or strangulation, and severe falls, which can result when a person attempts to climb over the rails from an increased height.

Key Points

• Entrapment: One main risk is entrapment, where a patient's body becomes stuck between the bed rail and mattress, leading to suffocation or strangulation, especially for frail or confused individuals.

• Severe Falls: The second main risk is severe falls, as confused or agitated patients may attempt to climb over the rails, falling from a greater height and suffering more serious injuries.

• At-Risk Population: Individuals with dementia, confusion, or limited mobility are most vulnerable to bed rail hazards, including both entrapment and climbing-related falls.

• Effective Alternatives: Safer alternatives to bed rails include lowering the bed, using bed alarms, placing floor mats, and increasing supervision, which reduce risk without resorting to physical confinement.

• Proper Assessment is Key: A thorough risk assessment is essential to determine if bed rails are appropriate for a specific individual, ensuring their potential benefits outweigh the serious, known dangers.

Understanding the Dangers: Entrapment and Severe Falls

While bed rails can offer a sense of security for caregivers, particularly with older adults who may be frail or prone to confusion, their risks often outweigh their perceived benefits. The two most serious and frequently reported dangers are entrapment and severe falls from climbing over the rails. These hazards are particularly pronounced for individuals with cognitive impairments, limited mobility, or who are on sedating medications.

The Risk of Entrapment

Entrapment is arguably the most serious risk associated with bed rails and occurs when a person's head, neck, or body becomes wedged in an opening. These incidents can lead to serious injury or death by suffocation or strangulation. The FDA and other safety agencies have identified several 'zones' where entrapment can occur:

• Between the rails: A person's head or torso can get stuck between the bars of the side rail itself.
• Between the rail and the mattress: This is a common and highly dangerous zone. If the mattress is not a perfect, snug fit for the bed frame and rail system, a gap is created. As the patient's weight compresses the mattress, this gap widens, creating a space large enough for a person to fall into and become trapped.
• Between the end of the rail and the headboard or footboard: A gap at the head or foot of the rail system can present another significant entrapment risk.

Frail, elderly, or confused individuals are especially vulnerable to entrapment. Their limited strength and awareness may prevent them from freeing themselves once caught. In some cases, a patient's breathing can become restricted if their chest is compressed by the mattress and rail, leading to fatal asphyxiation.

The Risk of Severe Falls

The irony of bed rails is that while they are meant to prevent falls, they can actually increase the severity of a fall if a patient attempts to climb over them. For a person who is confused, agitated, or simply determined to get out of bed, a bed rail is not a barrier but an obstacle to be overcome. In their attempt to climb over the elevated rail, they risk tripping or losing their balance.

Falls from a greater height can lead to more serious injuries than a simple fall from bed level, including:

• Head injuries
• Broken bones, such as hips or femurs
• Spinal damage

This risk is elevated for those with dementia or delirium, who may not fully comprehend the danger of climbing. For many, the instinct to get out of bed, perhaps to use the restroom, is stronger than their understanding of the hazard presented by the rails. A robust risk assessment is crucial to determine if a bed rail truly offers more benefit than risk for a specific individual.

Other Adverse Effects and Consequences

Beyond the two main physical risks, bed rails can have other negative consequences for a patient's physical and mental well-being:

• Psychological Distress: Being confined by bed rails can lead to feelings of isolation, claustrophobia, and agitation, especially for those with cognitive impairments. This can exacerbate confusion and lead to more restless, potentially unsafe behavior.
• Loss of Independence: For patients who are still capable of some mobility, bed rails restrict their ability to perform routine activities like getting to the bathroom independently. This can lead to a decline in muscle strength and overall physical conditioning, increasing dependency on caregivers.
• Bruises, Cuts, and Scrapes: Simply bumping into or rubbing against the metal or plastic rails can cause skin injuries, which are particularly problematic for elderly individuals with fragile skin.

Comparison: Bed Rails vs. Alternatives

Feature	Bed Rails	Alternatives
Primary Function	Physically block movement to prevent falls.	Reduce fall risk by accommodating patient needs and environment.
Main Risks	Entrapment (asphyxiation, strangulation) and severe falls.	No entrapment risk; different risks depending on alternative used (e.g., bed alarm malfunction).
Patient Experience	Can cause agitation, confusion, and feeling of restraint.	Often less restrictive and promotes greater independence.
Cost	Can be cheaper initially, but may lead to higher healthcare costs from injury.	Initial cost for specialized equipment may be higher, but reduces long-term injury costs.
Ideal Candidate	Very few, and requires constant supervision and proper bed/mattress fitting.	Most patients at risk of falling; individualized assessment determines best fit.

Alternatives to Bed Rails

Given the significant risks, especially entrapment and high falls, healthcare providers and families should explore safer alternatives. These options focus on addressing the root cause of the fall risk rather than physically restraining the individual.

1. Lowering the Bed: Adjusting the bed to a low position reduces the distance of a potential fall. Beds can be lowered to just a few inches from the floor, and floor mats can be placed alongside the bed for added protection.
2. Bed Alarms: These devices alert caregivers when a patient attempts to get out of bed. The pressure-sensitive mat or clip triggers an alarm, allowing staff or family to intervene quickly.
3. Increased Monitoring: Frequent checks by caregivers, especially during the night, can prevent a patient from getting out of bed unsupervised.
4. Assisted Devices: Using mobility aids like canes, walkers, or grab bars in strategic locations can help patients move independently and safely.
5. Addressing Behavioral Triggers: For individuals with dementia, restlessness or a desire to get out of bed may be a sign of a physical need, such as needing to use the restroom, or a behavioral trigger. Caregivers can learn to identify and address these needs proactively.

For more detailed information on safety guidelines and alternative strategies, consult authoritative sources like the U.S. Food and Drug Administration's guide to bed safety, available on their website at https://www.fda.gov/medical-devices/hospital-beds/guide-bed-safety-bed-rails-hospitals-nursing-homes-and-home-health-care-facts.

Conclusion: Prioritizing Safety Through Awareness

While bed rails were once seen as a standard safety feature, decades of data and unfortunate incidents have revealed their significant and dangerous risks. The two most critical hazards—entrapment and severe falls—are preventable through proper assessment and the use of modern, safer alternatives. By understanding these risks, caregivers and families can make informed decisions that prioritize the safety, dignity, and independence of those in their care. A focus on personalized care, combined with a willingness to move beyond outdated practices, is essential for a safer care environment.

Frequently Asked Questions

What is the primary danger of bed rails for seniors?

The primary danger is the risk of entrapment, which can occur when an elderly or frail person becomes caught in the gap between the bed rail and the mattress. This can lead to serious injury or, in worst-case scenarios, death by suffocation or strangulation.

How can bed rails cause more severe injuries from falls?

Bed rails can cause more severe fall injuries when a patient attempts to climb over them. Instead of simply rolling out of a low bed, they fall from an increased height, which can result in more serious injuries like head trauma or broken bones.

Who is most vulnerable to bed rail entrapment?

Individuals who are elderly, frail, confused, or suffering from conditions like dementia or delirium are most vulnerable to entrapment. Their inability to free themselves or understand the danger increases the risk significantly.

Are there regulations for using bed rails in nursing homes?

Yes, bed rails are heavily regulated in nursing homes due to their risks. Facilities must follow guidelines set by organizations like the Centers for Medicare and Medicaid Services (CMS) and conduct individualized risk assessments before use.

What are some safe alternatives to using bed rails?

Safer alternatives include using a low bed, placing floor mats next to the bed, installing bed alarms to alert staff when a patient moves, and implementing increased supervision and monitoring.

Why are bed rails sometimes considered a form of restraint?

Bed rails can be considered a physical restraint if they prevent a person who is capable of getting out of bed from performing routine activities. This can cause agitation and psychological distress, especially in those with cognitive impairments.

What should caregivers consider before using bed rails?

Before using bed rails, caregivers should perform a thorough risk assessment. They should consider the individual's specific needs, cognitive status, and potential for attempting to climb over the rails, weighing the risks against the benefits.