Reducing Falls at Night: What Family Carers Need to Know

As an occupational therapist, one of the most common concerns I hear from family carers is the risk of falls — especially at night. Many family carers tell me they are most worried about night time.

 

This is especially true for those supporting someone who lives alone or is far away, where you can’t always know what’s happening in real time.

 

This is not unwarranted anxiety; it is a valid concern.

 

Night-time brings a unique set of challenges:

·       Reduced lighting

·       Fatigue and slower reactions

·       Disorientation or confusion

·       Frequent and/or urgent trips to the bathroom

·       Less supervision or support available

 

All of these increase the risk of falls — and the consequences can be significant.

 

For carers living in the same home, night-time often means:

·       less sleep

·       staying alert

·       monitoring through the night

·       sometimes even sleeping in the same room

 

Over time, this leads to tiredness during the day, which affects everything else you are trying to manage.

 

A personal reflection

During my mother’s illness, as her mobility decreased, she had a fall while getting out of bed to go to the toilet and injured her head. After that, she became confused and didn’t fully recover. Things declined rapidly from there.

 

After her fall, I slept on a mattress on the floor in her room — hypervigilant at every sound, so I could help her when she needed the toilet at first, and later when she needed a commode.

 

I’m not sharing this to scare you or suggest this will happen to your loved one.

 

I’m sharing this because I see you. I know what this feels like — not just from a professional perspective, but as a daughter who was worried and trying to do the right thing.

 

Why falls matter more than we sometimes realise

A fall is rarely just a one-off event. It can lead to:

·       Physical injury

·       Loss of confidence

·       Fear of mobilising

·       Reduced independence

·       Increased reliance on others

 

Sometimes, it can mark the beginning of a wider decline. That’s why prevention is essential: it’s about creating a safer, more supportive environment, especially during the most vulnerable times.

 

What actually increases fall risk at night?

 

In practice, falls are rarely caused by a single factor. They are usually the result of a combination of things:

·       Muscle weakness or reduced balance

·       Poor lighting or unclear pathways

·       Clutter around the bed

·       Medication side effects (such as dizziness or drowsiness)

·       Cognitive changes (for example, dementia or even an infection)

·       Poor positioning or discomfort in bed

These factors often overlap — which is why a simple, practical approach can make a meaningful difference.

 

Simple ways to reduce risk around the bed

You don’t need to change everything. Some small, simple changes can significantly reduce risk:

 

1. Improve lighting

Ensure there is easy access to a bedside lamp. 

Motion-sensor night lights can help — but be mindful of placement. If they are too bright or directly in front of the person, they can be startling and make it harder to settle back to sleep.

My mum once told me she felt like “a criminal trying to escape prison with a spotlight on her.”

 

2. Clear the space

Keep pathways free from clutter.

Remove loose rugs or trip hazards.

Make sure essential items are within reach — including glasses if they are used.

 

3. Equipment

You can reduce the need to walk far by placing a commode or urinal bottle by the bed.

There are urinal bottles for women, as well as funnel options such as Shewee-style products.

If getting in and out of bed is difficult, bed grab handles or an adjustable (profiling) bed may be useful.

 

3. Look at bed height

Beds that are too high or too low increase the risk. Modern beds, especially with thicker mattresses, can be surprisingly high.

Adding mattress toppers can increase height further and may also shift out of place.

As a general rule, your loved one should be able to place their feet flat on the floor when sitting on the edge of the bed.

 

4. Think about positioning

Poor posture or discomfort makes movement more difficult. Supportive pillows or positioning aids can help maintain alignment and stability.

 

5. Be aware of medication and health changes

Notice any increase in:

·       dizziness

·       drowsiness

·       confusion

Even something like a minor infection can increase the risk of falls.

If something changes, it’s worth seeking medical advice from your loved one’s GP.

 

6. Technique matters

We all develop habits for getting in and out of bed. Most of the time, we do this on autopilot — until something changes.

Bed transfers are not just about safety; they are about confidence.

When someone feels unsafe, they move less, when they move less, strength and confidence decline, and this is how fall risk becomes part of a wider cycle.

Supporting safe mobility helps maintain:

·       confidence

·       independence

·       dignity

 

Where occupational therapy fits in

Occupational therapists look at the bigger picture. Not just:

“How do we stop a fall?” but: “How do we make daily life safer, easier, and more manageable for everyone involved?” and this includes:

·       Assessing the home environment

·       Recommending practical adjustments (furniture, small aids, equipment and techniques)

·       Supporting safe mobility and transfers

·       Helping family carers feel more confident

 

Where to start

If you take one step today, start with the space around the bed. Look at the environment with fresh eyes:

·       Is it easy to move around the bed and the bedroom safely?

·       Is everything within reach?

·       Would it feel safe in the middle of the night?

·       Is your loved one sleeping on the side of the bed closest to the toilet or door?

 

Remember: Small changes here can have a big impact!

 

Supporting you as a carer

Every caring situation is different. Cognition and memory issues, mobility difficulties, long-term conditions — they all bring their own challenges, but the foundations of safe care at home remain the same:

·       safe movement

·       clear environments

·       good positioning

·       practical, realistic strategies

 

If you’re looking for more structured guidance, you can explore the resources I’ve created for family carers:

Explore the Carers' Toolkits here or explore the Free Resources Library here.

 

Final thought 

Looking after your loved ones at home is not about getting everything perfect. It’s about doing the best you can, with the knowledge and support you have.

 

And sometimes, the smallest changes make the biggest difference!