No matter your age, a good night’s sleep can make all the difference to your mood, health and well-being throughout the day. That being said, elderly patients with complex needs may need quality rest more than other age groups, and this is particularly true if someone is recovering from an illness or injury in a rehab or long-term care community. That’s because sleep affects every part of our physiological and psychological health.
According to Erica Jansen from the University of Michigan, “[s]leep is essential to every process in the body, affecting our physical and mental functioning the next day, our ability to fight disease and develop immunity, and our metabolism and chronic disease risk.”1 Sleep is one consideration in the health of elderly people, but ensuring the safety of residents in these facilities can be surprisingly challenging, especially during those twilight hours when falls from beds can be particularly prevalent.
Consider this statement from the Industrial Safety and Hygiene News (ISHN): “A typical, 100-bed long term care community reports at least 100 to 200 falls per year.”2 In addition to this, a study by the Center for Medicare Advocacy found that only 57.5% of major falls are even reported.3 When considering both of these statements, there is clearly an elevated risk concerning falls, but it’s not necessarily insurmountable.
Falls due to frailty, medical conditions, restless sleep or medication side effects are just some of the dangers elderly residents face in LTCs. There can also be a significant scope for injuries to residents after they go to bed. The ISHN reported, “Faulty bed rails and incorrect bed height accounts for close to 30 percent of nursing home falls nationwide.”2 Other causes for these accidents include disorders such as benign paroxysmal positional vertigo (BPPV),4 general muscular weakness,5 cognitive impairment, or just the difficulty and disorientation anyone might face in adapting to a new environment.
Gone are the days when healthcare providers could use adjustable or built-in rails on beds as a safety measure to prevent falling from the bed. Due to entrapment risks and the significant risk factors of falling from an elevated height should the resident try to climb over the rail, bed rails are seen as a last resort to mitigate the risk of falls.
Falls can endanger long-term care communities as well as residents’ lives and health.
On his website SeniorJustice.com, attorney Michael Bredva warns, “Nursing homes have a legal duty to stop residents from falling. Failing to stop preventable falls is a form of nursing home negligence, and the results can be deadly. Nursing homes can be held liable for failing to stop a resident from falling.”6
It's clear to see, falling from beds does not only negatively affect the health and well-being of the patient but also the viability and financial security of the facility. As the number of falls increases, so too does the risk of legal implications and costly fines. In an already over-stretched industry, there is minimal room for error.
Fortunately, there are several solutions already available to prevent elderly residents from falling out of bed. Let’s consider three common interventions used for bed fall prevention in the elderly, as well as a recent innovation that is proving to be effective at reducing the risk of injury from bed falls. While it’s important to consider that not every fall-prevention device will be suitable for every elderly resident, having an understanding of the solutions available will help you to assess on a case-by-case basis. The first of these solutions is known as a low bed.
The height of an average bed is around 26 inches from the floor. Since the distance of a fall affects the velocity and consequent impact of a fall from the bed, bed height also affects the risk of severe injuries. Since a shorter distance to fall results in less velocity and a softer landing, it makes sense to lower the height of a bed to reduce the amount of harm a fall can cause. Low beds are created with adjustable bed frames that can be lowered to 9.5 inches high when the resident is sleeping and raised to 26 inches when they’re awake or to perform care tasks.7
Another benefit of this type of fall prevention bed frame is that when it’s raised to standard height (26 inches), most residents can put their feet on the floor when they sit up on the edge of the bed, giving them better leverage and stability when they get in or out. However, if the bed height setting isn’t adjusted before the sleeper tries to get up, the low height can make it difficult for them, especially if they have poor balance or if muscle strength is an issue.8 So, just how effective are low beds at preventing bed falls? Well, opinions differ on the overall benefit of low beds.
Dr. Patricia Quigley, a nurse consultant, nurse scientist, former associate director, and VISN8 Resident Safety Center of Inquiry, wrote on this topic for CurbellMedical.com. She pointed out that recent research indicates that “low beds do not appear to reduce fall risks during bed exit; rather, they may exacerbate them.” This is because it may be harder and take longer for elderly individuals to get up from a low bed than in higher beds.
Quigley’s main point is that the distance from the floor shouldn’t be the only consideration when it comes to determining the safest bed for a resident. Other factors, such as the resident’s height and physical condition, should be considered equally important in determining an ideal bed height for safe sleeping and safe movement during transfers from the bed.9
A mattress or mattress cover with raised edges is another option. Commonly known as a concave or scoop mattress, the edges on these mattresses are built higher than the center to keep the resident from rolling and therefore falling out of bed. The material of these barriers is soft, so if the sleeper bumps against them or has a health condition where they suffer from involuntary movements, they won’t suffer the kind of injury they might from traditional metal bed rails. The protective cover can also be easily wiped clean on the bed or removed for cleaning if an elderly individual suffers from incontinence.10
A less expensive version of this is a mattress cover designed to fit a standard-sized hospital bed with a pre-defined perimeter of foam cushioning around the edge.10 But while a bed with raised edges may help some to orient themselves in bed, it cannot prevent bed falls entirely.
Fall mats are assistive devices that lessen the possibility of injury from falls by reducing impact. An article in ElderlyFallPrevention.com states: “In laboratory tests, the risk of severe head injury is reduced to about 1% when falling from a low bed position onto a fall mat. This is compared to approximately 40% of injury risk occurring at normal bed height over a bed rail onto unprotected flooring (Bowers et al., 2008).”11
Fall mats, also called safety mats or floor mats, are typically one to four inches thick and have a non-stick surface with a beveled edge. They come in a wide range of colors to match different decors and can be placed on both sides of the bed. When the resident needs to get out of bed, the mat can be rolled back under the bed.12
Yet, these fall mats can cause falls themselves if they aren’t used properly. Walking on them is difficult for residents who have trouble with poor balance or gait challenges, and since the mats create an uneven floor surface, staff, as well as residents can easily trip on them. A proactive step in fall risk reduction here would be to ensure that floor mats are tucked under the bed or moved out of the way as soon as residents are awake and active.12
FloorBeds were first introduced by Accora in 2013, presenting a revolutionary new concept in beds for long-term care communities.14 These floor-level beds can be lowered to under 4 inches. And so, even with a thick or specialist scoop mattress, these beds are ultra-low and, therefore, ultra-efficient at preventing bed falls to give peace of mind and prevent injuries.
During the day, the FloorBed can be raised to a full standard height of up to 31.5 inches. This allows the resident to get out of bed safely and enables care nurses to make the bed and complete other care tasks at a comfortable height for them.
The FloorBed has all the profiling functions of a standard hospital bed, including Trendelenburg and Reverse or anti-Trendelenburg positions. And now, Accora also offers an exclusive enhancement – BodyMove™technology. This innovation shifts the pivot point back as the platform elevates, removing patient shear and reducing the average pressure over the sacral area by up to 23% compared to a standard nursing bed. This pressure-reducing measure can help with resident comfort, support skin integrity and assist with quality of sleep through reducing risks. You can't get a night of deep, quality sleep if you aren't comfortable, right?
Since the high safety mat is the same height as the bed, including the mattress, it creates an even sleeping surface the size of a double bed or even more if you choose to implement mats on both sides. This means they can roll out of bed without changing plane or sustaining fall-related injuries. The mat has a strong, non-slip base to ensure secure placement and is constructed to fold for easy storage during the day. Another safety plus is that because it’s higher off the ground than traditional fall mats, caregivers and residents are much less likely to trip on these mats than on ones closer to the floor, further mitigating the risk of falls.
Many elderly residents won’t be used to sleeping in a single bed prior to being in a long-term care facility, so adding that extra room is one preventive measure for bed falls that's paramount to their safety. Furthermore, feeling situated and at home in their wider bed may also help them get a good night of deep sleep in an unfamiliar place, which will only positively impact on their physical health. That’s what really puts the “care” into “long-term care” and also why Accora beds come in a variety of width options.
The assist bar is a movable assistive device that can be placed in several different positions on the bed frame without risking entrapment. It’s designed as an additional support to enhance the mobility of bed users getting in and out of bed without creating a restraint to their free movements.13 The assist bar is not a full bed rail, so it does not restrict; it enables independence. It is primarily useful for residents who have some strength to move in and out of bed, and it can assist with transfers between the bed and other assistive equipment, too.
Want to know more about Accora FloorBeds? Find out more here.
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Sources
1. Jansen,E. (2020) Sleep 101: Why Sleep Is So Important to Your Health. School of Public Health, University of Michigan.
2. Typical long term care communities report 100-200 patient falls per year. (2017) Industrial Safety and Hygiene News. 3. How Common are Falls in Nursing Homes. (2017) www.BermanLawyers.com,
4. Benign paroxysmal positional vertigo (BPPV) (2022) MayoClinic.org,
5. Horlings, C. Van Engelen, B., Allum, J., Bloem, B. (2008) A weak balance: the contribution of muscle weakness to postural instability and falls. NIH, The National Library of Medicine.
6. Brevda, M. (2020) Is a Nursing Home Liable for Falls? SeniorJustice.com.
7. Smith, H. (2022) Low Bed, Ultra-low Bed or Floor Bed: How to Choose. Rehabmart.com.
8. Quigley, P. (2021) Bed Height Must Be Individualized. Low Bed Height is NOT a Universal Fall Precaution. CurbellMedical.com.
9. Grant, S. (2022) Using a Fall Prevention Mattress to Reduce Falls from Bed. Graying With Grace.
10. Grant, S. (2022) 7 Ways to Keep the Elderly From Falling Out of Bed. Graying With Grace.com.
11. Teresa. (2022) Reducing Fall Injuries with Fall Mats. Elderly Fall Prevention.com.
12. Grant, S. (2022)Eight Best Fall Protection Mats for the Elderly. Graying With Grace.com.
13. Championing Dignity, enabling independence. (2022) Accora.
