It is 3 a.m. Your mother is on the floor somewhere between the bed and the toilet.
Do not begin by reconstructing the whole night. Begin with her.
Ask whether she is hurt. Ask whether she hit her head. Notice whether she is answering you normally. If you are deciding whether to call for emergency help or help her move, use the first ten minutes after a fall before you do anything else.
Once she is safe and the immediate questions are settled, do one small piece of work before the details disappear. Write down where the trip broke down.
Walk the six stops in order
The useful question is not simply, “Why did she fall?” That question is too large at 3 a.m. Use the same six stops each time: bed, bed edge, standing place, room path, bathroom turn, toilet.
Start at the bed. Was she fully in bed when you found her, sitting on the edge, or already on the floor? Were the covers tangled around her legs? Were her glasses, cane, walker, slippers and light switch within reach? Write only what you can see. Do not tidy first.
Move to the bed edge. Ask, “Did you sit here before you stood up?” Then ask, “Did you feel steady while you were sitting?” Record her answer in her own plain words. If she does not remember, write “does not remember.” Do not fill the blank for her.
Check the standing place. Look at where her feet would have landed. Note socks, slippers, a loose rug, a cord, bedding on the floor or furniture she may have reached for. Ask what she used to push up and what she reached for after standing.
Follow the room path. Leave the overhead light off for a moment only if it is safe for you to do so. Stand where she stood and look toward the bathroom. Can you see the doorway, the floor and the next place for her hand? Then turn the light back on. Record which lights were actually on when she got up, not which lights are available.
Pause at the bathroom turn. This is the place where the body changes direction and the walking aid may need to change direction too. Ask whether she was holding the walker, the doorframe, the wall, furniture or nothing. Note where the walker is now. Its location may help you understand whether she had it with her.
Finish at the toilet. Check whether clothing had already been lowered, whether she was turning to sit, whether she was reaching for toilet paper, or whether she had already stood back up. Do not treat “in the bathroom” as enough detail. Write the exact part of the movement.
Write down what happened before the fall
Use a single sheet of paper. Put it in one drawer and return every fall record to that drawer.
At the top, write the approximate time. Then record:
Where she started. What woke her or made her get up. Whether she called for help. What she used to walk. Which lights were on. The last movement she remembers. Where you found her. The direction she was facing. Where her glasses, footwear and walking aid were. Whether the bathroom trip was urgent. Whether anything about her behavior, speech or movement seemed different from her usual.
Add what happened earlier in the evening: unusual tiredness, poor eating or drinking, illness symptoms, a change in routine, or a medication taken differently from the usual plan. Do not decide what any of it means. Medication, dizziness, new weakness, confusion, pain and changes in bladder habits are clinical questions. Put them on the list for her physician rather than trying to diagnose the fall yourself. The desk’s public clinical references are collected on the sources page.
Circle the first failure
In the morning, read the record once. Circle the earliest stop where something went wrong.
If she could not get clear of the bedding, circle bed. If she slid while sitting, circle bed edge. If she became unsteady as she rose, circle standing place. If she lost the route or left the walker behind, circle room path. If she stumbled while changing direction, circle bathroom turn. If the trouble began while lowering clothing or sitting, circle toilet.
Do not circle the place where she landed unless that is also where the trouble began. A person can lose control at the bathroom turn and land several steps away. You are looking for the first failure, not the final position.
Compare records, not memories
After more than one incident, lay the sheets beside each other. Compare the same fields.
Look for one repeated stop. Look for one repeated movement. Check whether the walking aid was absent each time. Check whether every fall followed an urgent bathroom trip. Check whether the difficulty appears before standing, during straight walking, while turning or while sitting down.
Also compare the differences. A fall that begins with tangled bedding is not the same problem as a fall that begins with a sudden change in how she speaks or moves. Put any new or unexplained change on the physician list.
The record does not prove a cause. It gives the physician a cleaner account than “she keeps falling at night.” Bring the pages, her medication list and your questions to the appointment.
Ask the physician from the page
Start with the pattern you can show: “Three records begin when she first stands,” or, “The trouble appears when she turns toward the toilet.” Then ask:
Could a health condition or medication be contributing to this pattern? Does she need her vision, strength, balance, walking or bathroom urgency assessed? Should a physical therapist, occupational therapist or another clinician watch the full bed-to-toilet trip? What change would mean we should call sooner rather than wait for the next appointment?
Write the answers on the back of the same sheet. If the answer includes an evaluation or service, write who will order it, who will call you and what you should do if no call comes.
Keep the drawer simple
The drawer needs blank paper, a pen, her medication list, physician phone numbers and the completed records. Nothing more is required.
If you need help finding the right local doorway after the immediate night has passed, use Local help after a fall, St. Louis. If you are unsure which guide to read next, follow the reading path.
At 3 a.m., your job is not to solve every fall. Make sure she is safe. Walk the six stops. Write what you saw. Circle where the trouble began. Put the page in the drawer.
That is enough for the night.