When not to use bed rails? A critical guide for senior care

According to the U.S. Food and Drug Administration (FDA), bed rail-related injuries and deaths have been reported, highlighting the potential dangers associated with these devices. Knowing when not to use bed rails is crucial for ensuring the safety and well-being of older adults in your care.

Quick Summary

Bed rails are inappropriate and dangerous for individuals with cognitive impairments, advanced dementia, high agitation, or those who frequently climb out of bed, as they significantly increase the risks of entrapment, asphyxiation, and serious fall injuries. Safer solutions include comprehensive risk assessment and the use of low beds, floor mats, or transfer aids.

Key Points

• Cognitive Impairment: Avoid bed rails for individuals with dementia or confusion, as they may attempt to climb over them, increasing fall risk and potential for serious injury.

• Agitation and Restlessness: Bed rails can increase feelings of confinement and agitation, which can lead to attempts to escape and a higher chance of entrapment.

• Active Mobility: If a person is physically capable of getting out of bed independently, bed rails become an obstacle and a fall hazard, not an aid.

• High Entrapment Risk: Individuals with uncontrolled body movements, or those prone to slipping into small spaces, are at a high risk of getting trapped between the rail and mattress.

• Safest Alternatives: For fall prevention, safer options include using low-height beds, bedside floor mats, or bed alarms instead of physical barriers like rails.

The Hidden Dangers of Bed Rails

While often perceived as a simple safety measure, bed rails can introduce significant hazards, particularly for certain individuals. Understanding the potential risks is the first step toward creating a truly safe environment. For many seniors, bed rails can transform from an assistive device into a form of physical restraint that leads to agitation, confusion, and accidental injury.

Entrapment and Asphyxiation

One of the most severe risks is the potential for entrapment, where a person can become wedged in a gap between the bed rail and the mattress, between split bed rails, or within the rail structure itself. This can result in serious injury or even death by strangulation or asphyxiation, especially for those with decreased mobility or strength who cannot free themselves.

Increased Fall Severity

For residents who are confused or have dementia, bed rails can trigger a primitive instinct to climb over the barrier, leading to a fall from a greater height than if no rails were present. Such a fall from a standing position on top of the rails can result in more severe injuries, including head trauma and broken bones, compared to rolling out of a low bed.

Psychological Impact

Using bed rails can make individuals feel confined or trapped, leading to increased anxiety, fear, and psychological distress. This feeling of confinement can cause an increase in agitation and lead to aggressive attempts to escape, further increasing the risk of a fall and injury.

Conditions that Contraindicate Bed Rail Use

A thorough and ongoing assessment is essential to determine if bed rails are suitable. Several conditions should trigger caution and, in many cases, indicate that bed rails should not be used at all.

Cognitive Impairment and Dementia

Individuals with cognitive decline, Alzheimer's disease, or advanced dementia often lack the judgment to understand the bed rail's purpose. They may see it as an obstacle and attempt to climb over it, putting them at high risk. Agitation and confusion associated with these conditions can also escalate with the perceived restriction.

Agitation, Restlessness, and Delirium

For those experiencing episodes of delirium, severe pain, or generalized restlessness, bed rails can exacerbate the problem. The heightened state of confusion and uncontrolled body movements significantly increases the likelihood of a dangerous entrapment incident.

Physical Mobility and Independence

If a senior is physically able to get out of bed on their own, a bed rail may become an unnecessary and hazardous barrier. Rather than assisting with mobility, it becomes an obstacle that could lead to a fall. In these cases, the bed rail serves no purpose and introduces unnecessary risk.

Incontinence and Frequent Toileting Needs

For those who need to get up to use the toilet frequently during the night (nocturia), bed rails can be a major impediment. The urgent need to leave the bed combined with the obstacle can result in a panicked attempt to climb out, again increasing the risk of a serious fall.

Safe Alternatives to Bed Rails

Fortunately, numerous safer and more effective fall prevention strategies exist. The best approach involves a combination of techniques tailored to the individual's specific needs.

Comparison Table of Alternatives

Alternative	Key Benefit	Best for...
Low-Position Beds	Minimizes fall height injury	High fall-risk individuals
Fall Mats	Cushions fall impact	Unsteady individuals
Bedside Monitors	Alerts caregivers to movement	Individuals who wander
Transfer Aids & Trapezes	Assists with repositioning	Patients with upper body strength
Environmental Adjustments	Reduces overall trip hazards	All individuals for general safety
Bed Alarms	Alerts to attempted exit	Confusion or dementia
Occupational Therapy	Tailors solutions to needs	All individuals for personalized care

Implementing Alternatives

Using low-position beds that are kept close to the floor effectively removes the risk of a high fall. Placing fall mats next to the bed provides a cushioned surface in case of an accidental roll-out. For individuals who need help with repositioning or getting in and out of bed, strategically placed grab bars, transfer poles, or bed trapezes are excellent alternatives that provide assistance without creating a barrier.

The Bed Rail Assessment Process

Any decision to use bed rails must be based on a comprehensive, ongoing assessment by a healthcare professional. This process should evaluate the resident's physical and mental status, mobility, and the specific risk factors for their situation.

When to Use a Bed Rail with Caution

For individuals who are mentally alert and need a bed rail for a specific, conscious purpose (like a handhold to reposition), a partial-length rail may be used with caution. The individual must be fully informed and consent to its use, understanding it is a tool for assistance, not a restraint. Any use must be regularly reassessed to ensure continued appropriateness.

Ongoing Reassessment

An individual's physical and mental state can change. What was safe yesterday may be dangerous today. Regular reassessments are vital to ensure that bed rails remain the least restrictive and safest option for the least amount of time.

Conclusion: Prioritizing Safety

Bed rails are not a universal solution for fall prevention and can be dangerous under certain circumstances. By prioritizing a thorough risk assessment and implementing safer, less restrictive alternatives, you can protect the health and dignity of those in your care.

For official guidance and further information on bed rail safety, visit the FDA's Bed Rail Safety page. This resource offers valuable insights into reducing the risk of entrapment and other hazards associated with bed rail use.

Frequently Asked Questions

What is the primary danger of using bed rails for someone with dementia?

For individuals with dementia, the primary danger is that they may not perceive the bed rail as an assistive device but rather as a restraint or obstacle. This can lead to attempts to climb over the rail, resulting in falls from a greater height and more severe injuries, in addition to increasing agitation and confusion.

Are bed rails considered a form of restraint?

Yes, when used to prevent a person from getting out of bed independently, bed rails are considered a physical restraint. They should not be used for convenience or as a disciplinary measure and require a comprehensive assessment and justification for their use in a care plan.

What are the safest alternatives to using bed rails for fall prevention?

The safest alternatives include lowering the bed to its lowest possible position, using bedside mats to cushion a potential fall, and installing bed alarms that alert caregivers when someone attempts to get out of bed. Transfer poles and trapezes can also aid in mobility without creating a barrier.

When should bed rails be used with caution?

Bed rails may be used with caution for individuals who are mentally alert and capable of understanding their function as a handhold for repositioning or getting in and out of bed. In such cases, partial-length rails may be more appropriate, and their use must be agreed upon and regularly re-evaluated.

What is the risk of entrapment with bed rails?

The risk of entrapment occurs when a person becomes caught in the gaps between the mattress and bed rails, between split rails, or in the rail itself. This can lead to serious injury or death from asphyxiation, especially for those with altered mental status or reduced mobility.

What role does a care plan play in the decision to use bed rails?

Before using bed rails, a care plan must include a comprehensive assessment to justify their need and document that they are the least restrictive alternative. This plan should outline the specific reasons for their use, along with the risks and how they will be mitigated.

Can bed rails increase agitation in seniors?

Yes, for many seniors, especially those with cognitive issues, the presence of bed rails can lead to a feeling of being trapped or confined. This can significantly increase their agitation, anxiety, and confusion, which may provoke dangerous attempts to climb over the rails.