Bed rails are often seen as a straightforward solution for preventing falls and assisting mobility for older adults, but their safety is not guaranteed. These devices, typically metal or rigid plastic bars attached to the side of a bed, introduce their own set of risks. Determining whether a bed rail is safe depends entirely on the specific needs and cognitive state of the user, the design of the rail, and its proper installation. For many, they provide a sense of security and a stable grab point, but for others, they can quickly become a serious hazard.
The Difference Between Assist Rails and Restraint Rails
Bed rails are broadly categorized by their function, which affects both their design and their regulatory classification. Assist rails, also known as grab bars or half-length rails, are shorter and are placed near the head of the bed. They are primarily intended to provide a stable surface for the user to grasp when repositioning themselves, sitting up, or transferring in and out of bed.
Restraint rails, typically full-length, are designed to prevent the individual from exiting the bed. When a rail is used to stop a person from leaving the bed voluntarily, it is legally considered a restraint, which requires specific clinical justification and documentation. The intent of the rail—whether to aid movement or to restrict it—is the fundamental distinction between the two types.
Primary Safety Concerns and Injury Risks
The most significant danger associated with bed rails is entrapment, which occurs when a person’s head, neck, chest, or limbs become trapped in the spaces around the rail system. The FDA and the Hospital Bed Safety Work Group have identified seven distinct zones where entrapment can occur, including the gaps between the rail bars, the space between the rail and the end of the bed, and the gap formed between the rail and the mattress.
Between 1985 and 2009, 480 deaths were reported due to bed rail entrapment, highlighting the severity of this risk. Cognitive impairment, such as dementia or delirium, significantly increases the risk of entrapment, as confused individuals may attempt to climb over or squeeze through small openings. Physical frailty or agitation can also make a user more susceptible to becoming lodged in a hazardous space. Injuries can range from minor skin tears and bruises to suffocation and strangulation when the head or neck is trapped.
Other injuries result from falls that occur when a user climbs over the rail, falling from a greater height than if the rail had not been present. The presence of rails can sometimes induce agitated behavior in those with disorientation, leading them to attempt unsafe exits. These serious outcomes underscore why bed rails should be used only after a thorough individual risk assessment.
Guidelines for Safe Selection and Proper Installation
Mitigating the serious risks associated with bed rails begins with a comprehensive assessment of the user’s mobility, cognition, and agitation levels. The rail must be selected based on a specific clinical need, such as transfer assistance, rather than as a primary fall prevention strategy. Manufacturers recommend rails that meet current safety standards designed to eliminate the gaps that cause entrapment.
A crucial step is ensuring compatibility between the bed frame, the mattress, and the rail itself. The mattress should fit snugly against the rail to prevent hazardous gaps that could trap a body part. For portable rails, safety straps must be used to secure the rail to the bed frame or the opposite side of the bed, preventing the rail from shifting. Installation must follow manufacturer instructions, and the rail must be checked for stability before use.
The correct placement of an assist rail is also important for safety and effectiveness. Positioning a half-rail near the pillow area, where a person naturally sits to enter or exit, allows it to function as a stable handle. This placement supports independence while keeping the lower body free to swing out of bed, reducing the risk of climbing over a barrier. Regular inspection for wear, misalignment, or loose parts is necessary to maintain a safe sleeping system.
Practical Alternatives to Using Bed Rails
Given the inherent risks of bed rails, especially entrapment, several practical alternatives exist to improve bedroom safety. One highly effective solution is the use of ultra-low beds or floor-level profiling beds, which minimize the distance a person could fall. This reduction in fall height significantly lowers the potential for serious injury should a person exit the bed unintentionally.
Other strategies focus on providing assistance or alerts without physical barriers:
- Bedside mats: These soft, cushioned materials are placed on the floor next to the bed to absorb impact in case of a fall, reducing injury severity.
- Positioning aids: Foam bolsters or wedges can be placed under the fitted sheet to create a subtle barrier that reminds a person they are near the edge.
- Vertical transfer poles: These are tension-mounted from floor to ceiling and provide a stable grab bar for standing up or repositioning.
- Bed exit alarms: Pressure sensors under the mattress alert caregivers when a person attempts to leave the bed, allowing for timely intervention.
- Environmental adjustments: Improving bedroom lighting and removing trip hazards contribute to a safer environment.