BRIAN: Welcome to the SAFE with HSAG video podcast about nighttime fall safety.
My name, again, is Brian Grgurich, and I am an Associate Director with Health Services
Advisory Group, your Medicare Quality Improvement Organization in Arizona.
BRIAN: Getting up in the middle of the night to use the restroom can create a number of
fall risks.
On this podcast we will hear from two licensed physical therapists, Pamela Rivero and Justine
Ryan, who work with people just like you in their homes to stay safe from falls.
Pam and Justine will discuss a number of things with you that you can do to create a safe
environment in your home if you need to use the restroom during the night.
BRIAN: Pam, can you start by telling us how can someone set up their bathroom so that
the environment is as safe as possible if they need to use the bathroom at night?
PAM: There are a number of things you can do to make sure your bathroom is safe for
a nighttime walk before going to bed at night.
First, make sure there is good lighting in the bathroom.
Also, try not to use rugs in your bathroom.
Rugs should be only used if water will get on the floor and create a slippery surface.
If you do use a rug, make sure it has a skid back on it so it does not move.
Also, grab bars should be placed around the toilet for balance support.
You can also extend toilet heights for extra safety.
BRIAN: Justine, can you explain how someone should set up their bedroom before going to
bed at night?
JUSTINE: It is also important to ensure your bedroom is safe in the event you need to get
up in the middle of the night.
Most importantly, you need to make sure you keep the pathway clear between your bedroom
and the bathroom.
Also, make sure you can reach a light before you get into bed, whether it’s on a side
table, or even a nightlight.
A three-to-one light is also an option.
Sometimes, your bed covers might end up on the floor during the night and become a trip
hazard.
Therefore, make sure you bedding is tucked into your bed and out of the way.
And if you have limited mobility, you may need to bring in a bedside commode so you
don’t have to walk to the bathroom in the middle of the night.
BRIAN: Pam, what can be done before going to bed to reduce the number of times someone
needs to get up during the night?
PAM: There are a few things you can do to reduce the number of times you’ll need to
get up at night to use the bathroom.
One strategy is to choose an earlier time to stop taking in fluids.
In addition, stay hydrated throughout the day so that the urine does not get so concentrated
at night.
That is what irritates the bladder and makes you feel like you need to get up and use the
restroom.
Also, try laying down an hour before bed to reduce the need to go to the restroom at night.
This gets the urine to release prior to going to bed.
BRIAN: Is it a good idea to walk at night with socks or slippers?
JUSTINE: What you wear on your feet can also affect your fall risk at night.
Socks are not appropriate because your feet can shuffle in and out of the socks.
Socks can also cause you to slip and fall depending on the surface and the area where
you are walking.
Slippers with a back on the shoe will provide more support to avoid injury.
BRIAN: Where should assistive devices be kept before getting into bed at night?
PAM: Any kind of assistive device you need to use should be kept close to, yet within
reach, of the bed.
You can set up the bed area to make sure that these devices are stabilized so they don’t
fall down.
For example, if you have a cane, make sure it stays upright through the night and won’t
fall down completely.
You may trip on it if you don’t see it on the floor, or roll out of bed trying to pick
it up.
In addition, if you do have a bedside commode or a wheelchair, they should be positioned
at a 90-degree angle to the bed so you just have to stand up and make a 90-degree turn
to use these devices.
BRIAN: Justine, if someone needs to travel through a hallway to get to the bathroom at
night, how should the hallway be set up?
JUSTINE: It is also very important to make sure the hallway is safe from falls if you
make a nighttime walk to the restroom.
Most importantly, make sure the hall is clear of any obstacles.
Also, try not to place any throw rugs in the hallway.
If you truly need a throw rug make sure it is backed with tape or nonslip surface.
And make sure the corners aren’t up and could be tripped on.
Finally, hallways need to have enough lighting to make sure you can see where you are going.
BRIAN: What can be done on a routine basis to make sure the lights are working through
the night?
PAM: Making sure you have enough light to see is very important in avoiding falls while
you are walking at night.
You should check all of your home’s lights before bed to make sure they work.
Replace any burned-out light bulbs as soon as possible.
If you have any battery-operated lights, make sure you replace the batteries often.
In addition, you should have a battery-operated light as a backup in case of a power outage.
Also remember that it is not safe to use a flashlight at night while you are walking
because it does not light up the entire room.
This can make it harder to see and balance while you are walking at night to the restroom.
If you do need to use a flashlight, you should use one that lights up the entire room.
BRIAN: What can be done to make it as easy as possible to get on and off the toilet?
JUSTINE: There are a number of things you can do to make your toilet safer from falls,
as well.
You can use an elevated toilet seat or a three-in-one commode, for example.
Perhaps the most important thing to remember is not to use a towel rack to pull yourself
up from the toilet.
You need something more stable.
Having handrails installed next to the toilet can also help you balance as you get on and
off the toilet.
BRIAN: Thank you Pamela and Justine for your insights and advice on how everyone can make
their homes as safe as possible from falls—particularly if there is a need to use the restroom at
night.
And thank you for listening to this SAFE with HSAG podcast.
If you have any questions or comments, please email them to NursingHomes@hsag.com.
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This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality
Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human Services.
The contents presented do not necessarily reflect CMS policy.
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