You may have seen the elderly in your house become weak with advancing age. Aging makes them prone to falls and injuries. Consequently, falling can have implications on their functional health and well-being.
Families often report instances of older adults falling out of bed. While it may not be serious in all cases, some intervention to deal with this problem is necessary. So, let us analyze the problem in detail and learn how to prevent older adults from falling off the bed.
Who Are Affected The Most?
Falling from the bed is fairly common amongst older adults. According to epidemiological data, one out of every three adults who are older than 65 years tend to fall out of bed. As the age advances, the incidents increase, and the rate is higher among adults living in senior housing facilities.
While people often treat them as random events, adults falling out of bed can be indicative of several underlying conditions. A considerable amount of morbidity is associated with these falls.
After 70 years, these small morbid changes can lead to a dramatic increase in the risk of mortality. Old age is associated with increased fragility. Therefore, minor stressful incidents like these have severe impacts.
In otherwise healthy adults, these falls from the bed never really cause significant injury. However, most older adults have several underlying pathologies. Therefore, an increased propensity of falling out of bed can trigger long-term morbidity.
Apart from the physical implications of falling, it also affects the person mentally. According to research data, these minor falls are the reason behind the admission of older adults in community living facilities. As it reduces their independence, the mental state of the elderly gets disturbed.
Psychiatrists say that this loss of ability to ambulate is a major setback for many people. It is easy to slip into depression when such instances take place repeatedly.
As stated before, the people in the frail geriatric population suffer from age-related degenerative changes and diseases. These conditions are the most common cause of falling out of bed. Some affect their muscle strength, while others affect their senses, leading to the fall.
However, these conditions are seldom responsible for the falls alone. No single factor is responsible for these falls from the bed. Sometimes they start as accidental falls, and signs of influence of a disease are seen only after several instances.
Thus, these falls can have multifactorial origins, making the diagnosis difficult. Let us study a few common conditions associated with bed falls in the elderly.
Gait And Balance Disorders
Gait and balance disorders are the most common reason for any type of fall in the elderly population. Around fifty percent of the elderly have some kind of gait or balance impairment. In nursing homes, more than half the patients require support for getting up and walking.
These impairments occur either because of degenerative changes in the brain centers or due to muscle weakness.
When such older adults do not get support for moving in the bed or getting out of it, the chances of falling off the bed increase manifold. Without the proper use of assistive devices, these adults fall very frequently. Thus, it becomes a big physical and mental burden for them.
Arthritis is a common degenerative condition that affects a large part of the elderly population, especially those above 70. Osteoarthritis affects the weight-bearing joints of the body.
Therefore, when the elderly try getting out of the bed by putting weight on these joints, like the knee and the hip, they give way easily, leading to a fall. Using a good knee brace for arthritis pain relief can reduce stress on the joint, helping the person in moving easily.
Research conducted at Oklahoma Health University concluded that arthritis increases the risk of falling off the bed by 3 times. Weakness and gait changes associated with arthritis are also a cause behind the falls.
Depression is a pivotal factor that influences a lot of abnormal occurrences in geriatric life. The mechanism by which depression leads to falls in the elderly is not known properly.
However, it is believed that depression causes significant inattention, which may be a possible explanation for the bed falls. Moreover, when a person is depressed, the proclivity of risk-taking behavior increases suddenly. Both these can be explanations of how depression causes them to fall out of bed.
Sometimes depression influences the patient to take certain steps out of frustration. Such a reaction to the previous history of falls and the inability to ambulate can make the patient fall from the bed while trying too hard.
Since mild depressive symptoms occur in all older adults, doctors prescribe psychotropic medication commonly. Occasionally, these medications can cause muscle weakness that becomes a reason for the fall.
Cognitive impairment increases the chances of falling from the bed. Cognitive impairment is mostly associated with delirium, confusion, and dementia. All of these conditions make it difficult to adjust to the physical demands for activities of daily living.
Since the sense of spatial perception and orientation declines, the routine activities like moving out of bed become difficult for the patient. Like most other geriatric conditions, cognitive impairment worsens with advancing age. Thus, the frequency of bed falls increases after the age of 65.
Moreover, the situation is worse for institutionalized patients who already deal with several emotional problems. Escalation of cognitive problems to functional impairment is rapid in such patients, justifying the higher number of bed fall cases.
As morbidity increases with advancing age, the elderly have to take a lot of medications. These medications can have a direct relation with the increasing number of falls from the bed.
The most common medications, like those for the heart and high blood pressure, have side effects on other metabolic processes. These changes may increase frailty in geriatric patients, causing them to fall from the bed.
Polypharmacy may not be as dangerous as the previous set of risk factors, but the statistical data showing its correlation with falling from the bed is significant. Medicines like psychotropic agents, diuretics, and anti-arrhythmic medications can have such effects.
Several types of research are going on that focus on analyzing all these factors and ranking them in the order of relative importance. However, an adult falling from the bed is not a conventional health condition. While it may be random and accidental in one case, it may be suggestive of terminal impairments in the other.
The prevention strategies for adults who tend to fall out of bed need careful planning. The strategies lay equal emphasis on strengthening the weak muscles, modifying the environment, and reducing the risks around the elderly. There can be a different approach to fulfill these goals, depending on the condition of the elderly.
Assessment Of Risk Factors
A thorough assessment of the patient is the first step in this direction. You need to examine the patient for all underlying medical conditions. Check the mobility, and examine gait, balance control, vision, and cognitive abilities.
Review the history of falls and the circumstances that might have led to them. Note the medications and enquire about the functional well-being of the patient from the family. It is a focused approach to assess the risks for the bed falls.
Gait impairment, muscle weakness, and loss of balance are major risk factors leading to falls from the bed. Thus, the patient should regularly perform exercises that can strengthen these systems.
A geriatric physical therapist can provide the best assistance and guidance in this regard. Exercise programs are the most widely accepted bed fall prevention strategy. Progressive training is generally prescribed, where the patient strengthens large muscle groups first, followed by the smaller ones.
Similarly, a variety of exercises are prescribed to improve static and dynamic balance, important to move within and outside the bed. Exercises also help in improving the mental state of the patient by providing them a purpose or a task. There is documented evidence of a reduction in the bed fall instances in patients who follow an exercise regimen regularly.
Modifying The Environment
Sometimes the environment itself becomes a risk factor, causing the elderly to fall out of the bed. The presence of a lot of clutter around the bed, poor lighting, and lack of assistive devices for support are some of the risk factors.
A conscious effort to modify the environment to enhance the patient’s mobility can help in preventing them to fall from the bed. Using assistive devices like strong bed rails can help the patient in moving out of it easily.
Lowering the bed height is also a useful strategy. It ensures that the elderly do not hurt themselves even if they fall out. The cognitively stable people can use a self-administered home safety checklist to ensure that they feel safe in moving in and out of their beds. They are readily available with popular geriatric medicine journals.
Any of these for prevention strategies will not be useful unless it becomes a regular part of the caregiving programs. The family and the caregivers need to be vigilant to prevent these falls. Moreover, consultation from the doctor is a must.
So, as you can see, falling off the bed is not as insignificant as you may think. Trivial stressful incidents can have complex causes and implications in the case of the elderly. Thus, you need to take the repeated occurrence of such falls seriously. A few preventive measures and a bit of promptness can solve the problem easily.