What causes an elderly person to fall out of bed? A Comprehensive Guide

According to the CDC, more than one in four adults aged 65 and older falls each year, with many incidents occurring at night or in the bedroom. Understanding what causes an elderly person to fall out of bed? is the first step toward effective prevention and enhancing safety for your loved one.

Quick Summary

Falls can result from a combination of underlying medical conditions like orthostatic hypotension or dementia, side effects from certain medications, age-related mobility issues, and unsafe bedroom environments that create tripping or rolling hazards.

Key Points

• Medical Conditions: Underlying health issues, such as orthostatic hypotension, vertigo, and neuropathy, are often the root cause of bed falls in older adults.

• Medication Effects: Side effects from sedatives, antidepressants, and blood pressure drugs can significantly increase a senior's risk of falling due to dizziness or disorientation.

• Environmental Hazards: Simple bedroom hazards like poor lighting, incorrect bed height, and slippery surfaces can easily cause a fall, especially at night.

• Cognitive Impairment: Conditions like dementia and sundowning can lead to nighttime confusion, disorientation, and a higher propensity for an elderly person to fall out of bed.

• Prevention is Multifaceted: A combination of strategies—including medication reviews, bedroom modifications, and addressing mobility issues—is the most effective way to prevent falls.

• Slow Transitions: Encouraging a senior to get up slowly from a lying position is a simple but effective way to prevent dizziness caused by blood pressure changes.

Underlying Medical Conditions

One of the most significant factors contributing to nighttime falls is a variety of underlying medical issues common in older adults. These health problems can directly impact balance, mobility, and cognitive function, making getting out of bed a high-risk activity.

Cardiovascular and Neurological Issues

Orthostatic Hypotension: This is a form of low blood pressure that happens when you stand up from sitting or lying down. In older adults, the body's ability to regulate blood pressure can be slower, leading to sudden dizziness, lightheadedness, or even fainting when transitioning from a lying to a standing position. Getting out of bed too quickly at night for a bathroom trip is a common trigger.

Vertigo and Balance Disorders: Inner ear disorders, like benign paroxysmal positional vertigo (BPPV), can cause intense dizziness or a sensation that the room is spinning when changing head position. Simply rolling over or sitting up in bed can trigger a dizzy spell and lead to a fall.

Neuropathy: Nerve damage, often a complication of diabetes, can lead to numbness, weakness, or a tingling sensation in the feet and legs. This makes it difficult to feel the ground and maintain stable footing, especially in low light conditions.

Cognitive and Sleep-Related Problems

Dementia and Sundowning: Cognitive impairments from dementia or Alzheimer's can cause confusion and disorientation, especially at night. A phenomenon known as 'sundowning' increases agitation and confusion as evening approaches, leading a person to attempt to get out of bed without full awareness of their surroundings or physical limitations.

Sleep Disorders: Rapid eye movement (REM) sleep behavior disorder, where a person physically acts out vivid, often violent dreams, can cause them to flail limbs or thrash around violently, potentially rolling off the bed. Other sleep issues, such as restless legs syndrome, can also cause nighttime restlessness.

Incontinence: The urgent need to use the bathroom frequently at night, known as nocturia, can cause a senior to rush out of bed while still groggy or disoriented, significantly increasing the risk of a fall.

Medication Side Effects

Polypharmacy, or the use of multiple medications, is common in seniors, and many drugs can have side effects that increase fall risk. It is crucial to review all medications, including over-the-counter drugs, with a healthcare provider.

• Sedatives and Sleeping Pills: These drugs can cause prolonged drowsiness, grogginess, and unsteadiness, particularly upon waking in the middle of the night.
• Antidepressants: Some types can cause dizziness, sedation, and a drop in blood pressure.
• Blood Pressure Medication: Improperly managed or new blood pressure medications can contribute to orthostatic hypotension.
• Anticholinergics: Found in some medications for allergies, bladder control, and other conditions, these can cause confusion, blurred vision, and lightheadedness.

Environmental Hazards in the Bedroom

Even with a person's health in check, an unsafe bedroom can pose significant risks. Simple modifications can make a major difference.

• Inadequate Lighting: Poor lighting is a primary contributor to falls, especially at night. A senior may not see obstacles or misjudge their proximity to the edge of the bed.
• Incorrect Bed Height: A bed that is either too high or too low can make getting in and out difficult. The ideal height is when the person's feet can rest flat on the floor while seated on the edge of the bed, with hips just above the knees.
• Slippery Surfaces: Slick pajamas, bed sheets (like satin), or loose, unsecured throw rugs can create a slipping hazard.
• Clutter and Obstacles: Items like electrical cords, clutter, or misplaced furniture can become tripping hazards, particularly when a person is disoriented at night.

Prevention and Safety Measures

Fortunately, a proactive and multi-faceted approach can significantly reduce the risk of bed falls.

Home and Bedroom Modifications

• Install Bed Rails or Bolsters: These can create a physical barrier to prevent accidental rolling out of bed. Position-assisting bolsters or pool noodles under the fitted sheet are less restrictive alternatives.
• Optimize Lighting: Install nightlights along the path to the bathroom and ensure a lamp is easily accessible from the bed. Motion-sensor lights can also be a helpful addition.
• Eliminate Obstacles: Keep pathways clear of clutter, remove throw rugs, and secure any loose electrical cords.
• Adjust Bed Height: Evaluate and adjust the bed height to ensure it is easy and safe for the senior to get in and out of.

Medical and Lifestyle Management

• Review Medications: Regular medication reviews with a doctor are vital to identify and address any drugs contributing to unsteadiness or confusion.
• Encourage Slow Movements: Remind the person to sit on the edge of the bed for a minute or two before standing to allow their blood pressure to stabilize.
• Promote Mobility: Regular exercise, including walking, swimming, or tai chi, can improve strength, balance, and flexibility.
• Manage Chronic Conditions: Keep conditions like diabetes and arthritis well-controlled, and address any vision or foot problems that affect mobility.

Comparing Bed Fall Prevention Aids

Prevention Aid	Best For	Pros	Cons
Bed Rails	Accidental rolling, transfer support	Strong physical barrier, provides a solid grab point	Can be restrictive, potential entrapment risk, requires secure installation
Positioning Bolsters/Noodles	Restless sleepers, low-risk rollovers	Creates a subtle edge barrier, non-restrictive, low cost	Less secure for very restless sleepers, can shift easily
Bed Alarms	Caregiver notification, high-risk individuals	Alerts caregivers immediately when a person exits bed	Can be startling for the user, may cause anxiety
Fall Mats	Injury prevention	Cushioned surface reduces impact if a fall occurs	Can be a tripping hazard itself, may not prevent the fall

Immediate Actions After a Bed Fall

1. Stay Calm and Assess: Check for injuries without immediately moving the person. Ask if they feel any pain and where. Look for signs of injury like cuts, swelling, or bruises.
2. Determine Ability to Stand: If they feel able, guide them slowly through a process of moving to a kneeling position, then to a sturdy chair, and finally to a standing position.
3. Use Proper Lifting Techniques: If assistance is needed, ensure you have a clear plan and proper technique to avoid injury to both of you. Never lift a person without adequate support.
4. Contact Healthcare Professionals: If there is any confusion, pain, head injury, or inability to get up, call for medical help immediately. Always report the fall to their doctor.

Conclusion

Understanding the diverse factors that lead to bed falls—from medical complications to environmental and cognitive issues—is vital for ensuring senior safety. By taking a proactive approach that includes regular health monitoring, medication review, and simple bedroom modifications, caregivers and family members can significantly reduce the risks. Implementing assistive devices and being prepared for post-fall response provides an essential safety net, helping older adults maintain their independence with confidence and security.

Frequently Asked Questions

What are the first steps to take if an elderly person falls out of bed?

First, stay calm and assess the situation without moving them. Check for pain, injuries, or confusion. If they are uninjured and able, help them up slowly. If there is any head injury, significant pain, or confusion, call for medical help immediately and do not attempt to move them yourself.

Can certain medications cause a senior to fall out of bed?

Yes, many medications can increase fall risk. Common culprits include sedatives, sleep aids, antidepressants, and some blood pressure medications that can cause dizziness, confusion, or grogginess. A medication review with a doctor can identify any contributing drugs.

How can I make an elderly person's bed safer?

You can make a bed safer by using bed rails or bolsters to prevent rolling, ensuring the bed height allows feet to rest flat on the floor, and having a sturdy nightstand with an accessible lamp. Remove any loose throw rugs nearby and use a non-slip floor mat.

What is sundowning and how does it relate to bed falls?

Sundowning is a state of increased confusion and restlessness that occurs in people with dementia, typically in the late afternoon and evening. This disorientation can cause them to become agitated or try to get out of bed without being fully aware of their actions, leading to a fall.

Are bed rails always the best option for fall prevention?

Bed rails are an option, but they are not suitable for everyone and can pose a risk of entrapment. Alternatives like positioning bolsters (or even pool noodles under the fitted sheet), lower beds, and fall mats are often considered safer, less restrictive options, especially for those with cognitive impairment.

How can I help a senior with orthostatic hypotension get out of bed safely?

To help a senior with orthostatic hypotension, encourage them to move slowly. Teach them to sit on the edge of the bed for a minute or two before standing up completely. Having a stable handrail or sturdy furniture nearby for support can also be helpful.

Should I be concerned if a senior falls multiple times from bed?

Yes, repeated falls are a significant cause for concern and warrant an immediate medical evaluation. Multiple falls can indicate an underlying issue that needs to be addressed, such as a worsening medical condition, a new medication side effect, or an unresolved environmental hazard.