What are the alternatives to bed rails for elderly?

As elderly individuals age, mobility and safety often become a concern. Many seniors and their families consider bed rails as a solution to prevent falls and injuries. However, bed rails also come with risks. It is important to weigh the pros and cons of bed rails and explore alternative options to find the right solution for each individual situation.

Understanding the risks of bed rails

Bed rails or side rails are metal or rigid bars that attach to the bed to prevent the person from rolling or falling out. While bed rails may seem like an easy fix, they can also lead to unintended consequences:

• Entrapment – The FDA warns that bed rails carry the risk of entrapment which can lead to serious injury or death. Entrapment occurs when an individual becomes wedged between the mattress and bed rail.
• Strangulation – Bed rails near the neck and upper body may lead to accidental strangulation. This typically occurs when body parts become stuck between railings.
• Falls – Bed rails can actually increase the risk of falls as individuals attempt to climb over them. They may also get injured trying to lean over or through the rails.
• Skin injuries – Bed rails can lead to skin tears, bruises, and sores from repeated contact with the hard metal pieces.
• Agitation – For individuals with dementia or Alzheimer’s, bed rails can increase agitation as they may feel trapped or confined.

These risks have led medical organizations like the FDA and AARP to recommend against the routine use of bed rails. While they were once a common solution, better alternatives now exist to keep seniors safe.

Assessing the need for bed rails

The first step is to assess whether bed rails are truly needed in each unique situation. Consider the following:

• Physical mobility – How mobile is the individual? Can they get in and out of bed safely without assistance?
• Cognitive status – Are there cognitive concerns like dementia that may increase agitation or unsafe climbing over rails?
• Risk of falling – Have they fallen previously? Are frequent repositionings needed?
• Current safety measures – Are grab bars, floor mats or other safety measures already in place?
• Underlying conditions – Do they have any conditions, like arthritis or contractures, that limit mobility in bed?
• Individual preference – What does the person prefer for their safety and comfort?

Discuss these factors and risks openly with medical providers to determine if bed rails warrant consideration.

6 alternatives to bed rails

For those at risk of falling or with mobility impairment, there are a number of options to provide security other than bed rails. Consider these bed rail alternatives:

1. Adjustable beds

Adjustable beds have electric motors to raise the head and feet to different angles. This allows the individual to adjust the bed into a chair-like sitting position or raise the feet which can help prevent sliding down. Adjustable beds also make it easier to get in and out of bed compared to low beds. Models with programmable memory positions can store favorite settings.

2. Bed handle attachments

Padded bed handles or grip attachments fasten to the side of the mattress without bars across the bed. This provides support for getting in and out of bed or repositioning without risk of entrapment. Handles give the person something secure to grab onto without getting in the way.

3. Bed assistance devices

A variety of assistive devices are available to make bed mobility safer such as bed ladders, rails, and trapeze handles installed overhead. These options allow the senior to pull themselves up to sit or stand. Other devices like leg lifters are designed to move legs into position. Assistance devices require enough upper body strength and coordination to operate safely.

4. Mattress sensor pads

Sensor pads and monitors placed under the mattress can alert caregivers if the senior gets out of bed unassisted. Some devices trigger an audible alarm when weight is removed while others send alerts to a remote caregiver. This technology tracks activity andmovement to prevent unsafe wandering or falls.

5. Low beds and floor mats

Placing mattresses close to the floor reduces injury risk if an individual does fall out of bed. Soft padded floor mats on both sides provide cushioning as well. For those at high fall risk, the bed frame can even be removed to place the mattress directly on the floor until safer mobility is achieved.

6. Repositioning schedules

Individuals with limited mobility have difficulty repositioning themselves in bed leading to skin breakdown and falls when trying to do so. Planned repositioning on a schedule helps prevent this. More frequent check-ins and rollings by caregivers provide needed assistance for those at high risk.

Choosing the right alternative

The best solution depends on the senior’s unique needs and environment. Key factors to consider include:

• Mobility level – Is bed assistance needed for support getting up or prevention of falling out?
• Cognitive ability – Will devices confuse or agitate individuals with dementia?
• Caregiver access – Are home caregivers available to assist with scheduled repositioning?
• Living situation – Is adjustable bed technology feasible in their current home setting?
• Financial considerations – What safety solutions fit within their budget? Are any covered by insurance?
• Personal preferences – What will provide them the greatest sense of safety and dignity?

Occupational therapists can help assess needs and trial different options. It is ideal to include the senior and caregivers in selecting the strategies they are most comfortable with.

Precautions when using alternatives

While hospital beds, assistive devices, and sensor pads are generally safer than bed rails, precautions are still needed to prevent injury. Tips include:

• Ensure proper fit and installation
• Keep cords and tubes out of the way to avoid tripping
• Use retained mattresses to prevent gaps
• Place floor mats around the bed
• Respond quickly to sensor alerts
• Lower beds fully when unattended
• Engage locks on wheeled beds before transferring

Routinely check that devices are in good working condition. Ensure the senior can properly operate handles and other assistive equipment as well. For those with Alzheimer’s or dementia, additional supervision may be warranted.

Examples of bed rail alternatives

Here are some examples of products that can provide bed mobility assistance without the risks of full rails:

Product	Description
Bed handle	Padded handles fasten to mattress edges without bars across bed
Grippole	Support grip attaches near pillows for leverage getting up
Bed ladder	Ladder with wide rungs sits alongside bed for support steps
Trapeze bar	Overhead bar with handle allows patient to pull themselves up
Leg lifter	Strap device helps move legs into position
Sensor pad	Thin monitor slips under mattress to detect bed exits

Working with occupational therapists

Occupational therapists, also known as OTs, are professionals who help seniors and people with disabilities or injuries maintain independence. They recommend adaptive solutions and techniques for activities of daily living based on each person’s physical and cognitive capabilities.

For those at risk of falls getting in and out of bed, an OT can conduct a home evaluation and bed mobility assessment. They may observe the senior attempt to get up or turn and note any balance issues or use of surrounding objects for support. OTs can suggest options to make this safer such as bed rails or handle alternatives.

Occupational therapists also consider bathroom access, lighting needs, and flooring hazards. They may demonstrate techniques for safer bed mobility, including use of mobility aids. OTs work closely with physicians, nurses and caregivers to integrate medical recommendations.

To find an OT, ask hospitals and home health agencies for referrals. Licensing boards can also help locate qualified occupational therapists in your state or region.

Training caregivers on proper use

For seniors receiving home care services, their caregivers should understand proper utilization of any mobility aids or devices selected. The training an occupational therapist provides allows caregivers to reinforce these strategies on a daily basis.

Key training tips for caregivers include:

• Ensure devices are always within reach before patient uses bed
• Assist with prescribed repositioning techniques and schedule
• Keep floor paths clear for bed access
• Respond immediately to sensor alarms
• Report any new safety concerns right away
• Encourage use of devices but avoid forcing if resistant
• Provide standby assistance as individual learns new techniques

Refresher training may be needed if the senior’s abilities change over time. Open communication between OTs, caregivers and family members ensures everyone remains on the same page regarding the current safest strategies.

Adapting the home environment

In addition to bed modifications, evaluate the senior’s home environment more broadly for safety risks. Proper lighting, cleared paths and accessible bathroom facilities help prevent falls.

Tips for adapting the home include:

• Ensure adequate lighting in all rooms and hallways
• Remove loose rugs, cords and clutter that may cause tripping
• Install grab bars, handrails and ramps where needed
• Use chairs with high, firm seats for easier transfers
• Keep frequently used items within easy reach
• Modify bathrooms with raised toilets, shower seats

Aging-in-place home modifications maximize independence for longer. Therapists can recommend changes based on individual needs and abilities. Home health agencies may offer assistance as well.

When to consider bed rails

While bed rails carry risks, they may still be an appropriate solution in some cases if all other options have been exhausted. Potential instances where bed rails could be beneficial include:

• As a reminder of bed boundaries for those with severe cognitive impairment
• During temporary illness when mobility is severely impacted short-term
• As an adjunct to other safety aids for those at very high fall risk
• For comfort providing a feeling of security when other options fail

Note that full four-sided bed enclosures are almost never recommended today due to entrapment hazards. Always consult a doctor or occupational therapist before pursing bed rails even in limited situations.

Using bed rails safely

If bed rails are ultimately recommended, proper precautions must be taken to allow for their safest possible use:

• Ensure proper installation and fit with the mattress
• Use wider rails with spaces less than 4-6 inches
• Place padding on rails to prevent injuries
• Raise and lower portions of rails as needed
• Routinely reassess continued need for rails

Additionally, the senior’s condition should permit the following:

• Sufficient mobility to get in and out of bed with rail assistance
• Adequate cognition to understand proper rail use
• No serious underlying risk for entrapment or strangulation

Rails should be seen as temporary measures and removed promptly once risks allow. Fully informing the senior and all caregivers about rail hazards remains crucial as well.

Conclusion

Bed rails were once the default solution for bed safety but pose serious risks that call for other options to be considered first. Today’s adjustable beds, monitors and mobility aids allow falls and injuries to be prevented without risk of entrapment. With some preparation and training, bed rails can be avoided in most senior bedroom settings.

The most effective approach involves a thorough assessment of the individual’s needs and environment by a qualified occupational therapist. They can help determine if any form of bed modification is truly warranted, and if so, the safest and most appropriate solution for each situation. With proper alternatives to bed rails, seniors can stay safe and sleep comfortably.