Bed Height and Getting Out of Bed Safely

Why bed height matters

Standing up means lifting the body weight from sitting by straightening the hips and knees. The lower the seat, the more work is required from the thigh and buttock muscles. For someone with weak legs, painful knees, a hip replacement, Parkinson's disease or general frailty, a seat that is too low may be impossible to rise from without help. A seat that is too high means the feet may not reach the floor, and the person has to slide down, with a risk of dropping to the floor.

The right height gives:

• Feet flat on the floor when sitting at the edge of the bed.
• Knees at about a right angle or a little above, with thighs roughly level or sloping slightly downward.
• Hips higher than the knees if standing is difficult, since this reduces the work of rising.

Many guides suggest a bed surface height (top of mattress) of about 45 to 55 cm for adults, though taller and shorter people need different heights. A person who is tall may need a higher bed; a short person a lower one.

How to measure for the right height

1. Ask your parent to sit on the edge of the bed, in their usual footwear or barefoot as they normally are. 2. Check whether their feet are flat on the floor and their knees are bent about 90 degrees. 3. Measure from the floor to the back of the knee, and compare with the height of the top of the mattress when compressed under their weight. 4. Watch them stand up. Do they need to rock, push with both hands or struggle? Do they sink into the mattress? 5. Note the mattress thickness and softness. A soft mattress compresses and effectively lowers the seat height at the edge, making standing harder.

If the bed is too high, the person may be unable to reach the floor, or may find it frightening. If too low, they may be unable to stand.

Changing the height

If the bed is too low:

• Bed raisers. Sturdy blocks or risers under the legs can lift an ordinary bed by several centimetres. Use only products rated for the bed and the weight, with a firm grip for the legs. Poor risers can slip or collapse. Beds with a central support or drawers may need special raisers.
• A thicker or firmer mattress. A firm, supportive mattress raises the surface, and reduces sinking at the edge. See mattress firmness for back pain.
• A firm edge. Some mattresses have a firm edge, which gives a better sitting surface.
• A hospital bed or adjustable-height bed. The height can be set to suit the person, and lowered or raised for care; see hospital bed buying guide.
• An alternative to an old, low bed. In some homes a charpai or floor mattress is too low for an older person. A raised bed frame may be needed.
• A chair or bed with arms near the bed to help standing; see helping an elderly parent stand from a chair.

If the bed is too high:

• Reduce the height by removing a thick extra mattress, using shorter legs or choosing a low-height adjustable bed.
• Provide a stable step, such as a firm, non-slip footstool with a handle, particularly if lowering is not possible. Steps themselves can be a tripping hazard, so only use if the person is steady.
• Use an adjustable bed that can be lowered.

Do not stack mattresses on an unstable base or use unsuitable items such as bricks as raisers.

Making the bed edge safe

• Firm edge. A mattress with a soft edge collapses as someone sits on it. A firm edge or a sturdy bed frame is safer.
• Non-slip floor beside the bed. Remove loose mats and rugs; see flooring, rugs and trip hazards.
• Bed against a wall on one side, or well fixed, so it does not slide when pushed.
• Brakes on if the bed has wheels.
• Bed handle or rail, if suitable, to help sit up and stand; see bed rails guide. A short assist handle is often safer than a full rail.
• Light. A lamp within reach and a night light on the route; see motion-sensor night lights.
• Walking aid within reach, set at the right height; see walking frame buying guide.
• Footwear with grip beside the bed, or a non-slip mat.
• Clear path. To the toilet and the door; see bedroom setup for night safety.
• A chair with arms close to the bed, to sit in for dressing.

Getting out of bed: a safe method

A general method, which a therapist may modify for your parent:

1. Wake fully. Do not jump up. Lie still for a few seconds. 2. Roll onto the side you will get out from, bending the knees. 3. Push up with the arms while swinging the legs over the side of the bed, so that the trunk rises as the legs come down. 4. Sit on the edge of the bed for at least a minute, feet flat on the floor. Take some deep breaths and move the ankles. This allows blood pressure to adjust; see dizziness and low blood pressure when standing. 5. Check for dizziness. If lightheaded, stay sitting or lie down. 6. Place the feet slightly apart, with one foot a little behind the other. 7. Lean forward with the nose over the toes, put the hands on the mattress or on a firm support beside you, and push up. 8. Stand and pause with a hand on a stable support. Wait a few seconds before walking. 9. Take the walking aid and step off, with good light.

To get back into bed, reverse the order: back up until the legs touch the mattress, reach back with both hands, sit, then swing the legs up and lie down on the side.

If your parent has had hip surgery, a stroke or other condition, follow the rules their therapist has given. See bed transfer techniques.

Helping someone get up

A carer can help, but the carer's body is at risk too.

• Stand beside, not in front, to guide and guard.
• Use a transfer belt if the therapist recommends it; see how to use a transfer belt.
• Do not pull on the arm, especially after stroke.
• Count together "one, two, three, up".
• Keep your back straight, bend at the knees and hips, and avoid twisting.
• Raise the bed height if it is adjustable, for the person to stand, and lower it for sleeping.
• Do not lift a person yourself if they cannot bear weight; call for help or use a hoist or sliding board. See how to lift and transfer safely.

Common mistakes

• Using a very soft mattress that sinks.
• Raising the bed on unstable stacks.
• Having a bed so high the feet dangle.
• Leaving the person to stand immediately after waking.
• Having no light or support.
• Using rails to pull up when the rail is loose.
• Placing a walker at the foot of the bed where the person cannot reach it.
• Forgetting the brakes on a wheeled bed.

When to ask a professional

An occupational therapist or physiotherapist can assess how your parent gets up, adjust bed height, recommend equipment and teach a safe method, and are especially helpful after a stroke, hip or knee surgery or with Parkinson's disease. A doctor should check dizziness, repeated falls, new weakness or night-time confusion. A nurse can advise on skin and mattress. If your parent falls from bed, see what to do after a fall.