Night-Time Falls: Why They Happen and How to Prevent Them
A significant proportion of falls in older adults occur at night — typically when getting out of bed to use the bathroom. These falls are particularly dangerous because they occur in low light, the person may be disoriented from sleep, and help may not be immediately available. Understanding the causes allows effective prevention.
The scenario is common: an older adult wakes with the need to urinate, gets out of bed in the dark, navigates to the bathroom (possibly along a hallway, around furniture, or through a door), uses the toilet, and returns to bed. At every stage, fall risk factors are amplified. The person may be disoriented from sleep. Vision is impaired in low light. Blood pressure may be low (particularly if they have taken evening blood pressure medication). Mobility may be stiff after lying still. And the urgency of a full bladder may cause them to rush.
Several factors contribute to night-time fall risk. Nocturia — the need to urinate at night — affects most older adults and is a primary trigger for getting out of bed. Causes include prostate enlargement in men, overactive bladder, urinary tract infections, diabetes, and simply the reduced bladder capacity of ageing. Reducing evening fluid intake and managing underlying medical conditions can reduce nocturia frequency.
Medications taken in the evening can contribute — diuretics, blood pressure medications, and sedatives can all increase fall risk at night. A medication review with your GP may identify adjustments that improve safety.
Practical prevention strategies include: installing motion-activated night lights along the path from bedroom to bathroom, keeping the path clear of obstacles, ensuring appropriate footwear (non-slip socks or slippers with backs) is within easy reach of the bed, considering a bedside commode or urinal to eliminate the need to walk to the bathroom, ensuring grab rails are installed in the bathroom and along the route, and using a personal alarm worn at night.
Our falls prevention service addresses night-time fall risk as part of a comprehensive home hazard assessment. Our elderly physiotherapy service addresses the balance and mobility factors, while our post-hospital rehabilitation service supports patients recovering from night-time falls.