Aging Begins at 30

"Safe Beds That Kill "

In skimming some medical journals my eye caught a title "Death Caused By Bed Rails" and it reminded me of Mr. Jones, aged 80, hospitalized for pneumonia. He knew his name but could not name the President of the United States or the hospital he was in. Various devices were used to get Mr. Jones to use the call light to request assistance. He was found several times wobbling across the room to the bathroom. Ultimately, his side rails were put up. The next time he fell climbing out of bed and broke his hip. We often ensure "safety" by sacrificing other values. In another incident an 85 year-old was found on hands and knees on the floor beside the bed. The bed rails were up. Accidents and lawsuits are less expensive when it can be proven that the side rails were up.

This new survey of data in the National Injury Information Clearinghouse from 1993 to 1996 revealed 74 deaths nationally. In 70% the patient was trapped so that the face was pressed against the mattress. In 18% the neck was caught within the rails. In the remainder, death was caused by being trapped by the rails after sliding partially off the bed and having the side flexed or the chest compressed

In hospitals bed rails are generally used as a nursing decision but in nursing homes due to accidents int he past, federal regulation requires a doctor's order. Bed rails seem so benign that they are used without consideration with after treatment and without any regulation as to their design. Seventy percent were women and 70% of the deaths occurred in people older than 70. Graphic pictures were made of reenactments of the deaths. There were no photos available. The need to urinate is the major reason that older persons climb or try to climb over bed rails. An additional 225 injuries not involving death were described. Confusion, restlessness, and prevention of muscle contral were prime problems related to death. Physicians in the U.S., the U.K., and Canada have been alerted about these problems. Bed rails are clearly indicated with the delirious, unconscious, or intoxicated patient and when the patient is going to be transported on a gurney. Canada is using studies to develop national standards for beds, bed rails, and mattresses. One quarter of mattresses are replaced each year, but beds last 20 years and even the best designed standards can vary with use. Bed rails are used in 8% of U.K. patients and many were in the U.S., where Bed Rails are often used continually for patients aged 65 and over.

Public concern and regulation was mobilized quickly in relation to deaths of a few children from airbags. This larger problem of unnecessary deaths in the elderly requires immediate attention. The caregiver should be the provider of restraints with acceptable limits of safety. First of all we must do no harm.

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