Academic journal article British Journal of Occupational Therapy

Older People Falling out of Bed: Restraint, Risk and Safety

Academic journal article British Journal of Occupational Therapy

Older People Falling out of Bed: Restraint, Risk and Safety

Article excerpt

Opinion

Bedside rails are used for older people's safety in order to prevent them from falling out of bed and suffering injury. Bed rails can constitute restraint and the principles underpinning mental capacity legislation illustrate good practice when equipment is used in ways that may restrict people's freedom. The use of bed rails illustrates broader tensions in the care of older people: tensions between ensuring the safety of older people and maintaining independence and freedom, including older people taking risks. Person-centred care emphasises that the views of older people, their family carers and the professionals must all be taken into account when assessing older people's care needs and developing risk assessments and care plans. There needs to be further education and debate about positive practice in the use of bed rails because, all too often, the use of these devices is taken for granted. Staff need support to ensure that they put the best interests of older people at the centre of all decisions about their care.

Key words: Older people, bed rails, restraint.

Falls, risk and safety

Older people who fall out of bed risk injury. People may fall accidentally because they slip or slide from the bed when they move to reposition themselves or when they are agitated, anxious or confused. There are a number of techniques that are used as a barrier or an obstacle to prevent people falling out of bed. Bedside rails form a barrier to contain individuals within the bed and are used for the safety of older people. They are used across health and social care settings, including people's own homes, care homes, hospitals and hospices. Bedside rails can help to prevent older people from falling from bed and injuring themselves. However, this equipment may also be used to prevent people from leaving a bed and, in these circumstances, may constitute restraint. Furthermore, bed rails may act as a psychological barrier to discourage people from leaving their bed, especially when they are agitated or confused. Bed rails have even been described as a form of 'imprisonment' (Dimond 2004).

Occupational therapists, both in the United Kingdom (UK) and overseas, have raised concerns about the use of restraints (Carruthers 2001, Dimond 2004, Lavery 2005). A broad definition of restraint emphasises the restriction of someone's freedom. More specifically, it is important to define the ways in which people's freedom can be restricted:

   ... any device, material or equipment attached to or near
   a person's body and which cannot be controlled or easily
   removed by the person and which deliberately prevents
   or is deliberately intended to prevent a person's free body
   movement to a position of choice and /or a person's normal
   access to their body (Retsas 1998, p186).

The unnecessary limits to people's independence or choice in decisions about their own health and social care arrangements and lives sit uncomfortably with the principles of person-centred care in occupational therapy. Safe therapeutic environments, characterised by a philosophy of least restraint, and the promotion of independence are hallmarks of good quality practice. Lavery (2005) suggested that risk prevention was overemphasised in discussions about restraints and argued that there should be a sharper focus on people's rights. She noted that families and carers might place undue pressure on professionals to use restraint when the focus must first be on the rights of the older person himself or herself. This may not necessarily mean putting safety first.

Bedside rails tend to be used for safety reasons; however, they have not been found to reduce the incidence of bed-related falls and injury (Capezuti et al 2007). They may even constitute a risk to older people in bed, because people may fall from a greater height as they try to haul themselves over the rails. Rails used on beds that are not designed for the equipment, or rails that do not take into account individuals' size and weight, can cause additional problems (Hignett and Griffiths 2005). …

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