The morning after
Why does my mom fall more at night? The bed-to-bathroom walk, stop by stop
She does not fall in the kitchen at noon. She falls between the bed and the toilet at two in the morning. That is not bad luck. It is a route, and it can be walked.
Why does my mom fall more at night? You have asked it out loud to a sibling, a nurse at the front desk, the ceiling. The public fall-prevention material answers it, scattered across a few government pages. This piece pins each part to one stop on the walk from her bed to her bathroom. None of it is a diagnosis. Each stop ends with the question it gives you for her doctor.
What is different about 3am?
Five things, and they stack. In daylight she has one at a time. At night she has all five in the space of eleven steps.
1. It is dark, and she is not turning the light on
The National Institute on Aging's room-by-room page starts from the fact that many falls happen at home, where we move around without thinking about our safety, and its bathroom advice is specific: leave a light on in the bathroom at night, or use a night light that comes on by itself, and put night lights and switches close to the bed. Ask her where the switch is. If the answer is "on the wall, by the door," she is walking blind to reach it, and NIA lists eyesight, hearing and reflexes that are not as sharp as they were among the reasons an older person falls.
2. She is in a hurry
Nobody says this one out loud. She is not strolling to the bathroom at 2am; she is trying to get there in time. NIA names it as a cause: conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling. The CDC's twelve-question self-check, Stay Independent, has a line for it, "I often have to rush to the toilet," and its note beside it is your situation exactly: rushing to the bathroom, especially at night, increases your chance of falling. The fix is not "walk slower." It is a conversation with her doctor about why she has to rush.
3. Her blood pressure drops when she stands up
Lying flat for hours and then standing straight up is hard on anybody's blood pressure. NIA lists blood pressure that drops too much when you get up from lying down or sitting, called postural hypotension, as a risk factor, and says to stand up slowly because getting up too quickly can make you feel wobbly. The CDC's brochure on it adds two details that matter at night: symptoms are more likely in the morning, when blood pressure is naturally lower, and when straining on the toilet, and the way out of bed is in stages: sit up, sit on the side of the bed, then stand. That is stop two on the walk, and it is why this desk keeps telling her to sit there and count.
4. Something she took at bedtime
NIA: some medications can increase a person's risk of falling because they cause side effects such as dizziness or confusion, and the more medications you take, the more likely you are to fall. The CDC self-check asks whether she takes medicine that makes her light-headed or more tired than usual, and whether she takes medicine to help her sleep or improve her mood. A pill taken at 9pm is at full strength at 2am. What to do about that is the pharmacist's and the doctor's. Your job is the bag of boxes, including the over-the-counter ones.
5. The route has three obstacles she does not see
The rug at the bedroom door. The lamp cord. The laundry basket that was not in the hall last week. NIA names safety hazards in the home as a cause of falls, says not to use throw rugs at all, and says to keep cords by the walls and the floor clear. On her feet, NIA says not to walk on floors in socks or in slippers with smooth soles, and names backless shoes as unsafe. Backless slippers are the standard 2am shoe: one obstacle she carries with her.
One more, quieter. NIA's prevention list includes get enough sleep, because if you are tired, you are more likely to fall. A woman getting up three times a night for a month is not rested at any of the three.
Walk the route with her, in daylight
Do it on a Saturday with the curtains drawn, and let her lead. Watch where her hand goes.
- Stop 1, the lamp. Can she turn a light on without sitting up? NIA: night lights and light switches close to your bed.
- Stop 2, the edge of the bed. Does she sit first, or swing straight up? The CDC's order is sit up, sit on the side, then stand.
- Stop 3, the doorway. Is there a rug? Where does her hand go?
- Stop 4, the hall. Count what is on the floor. NIA suggests motion-activated plug-in lights.
- Stop 5, the bathroom light. On before she goes in, or reached for in the dark?
- Stop 6, the toilet. What does she hold to sit and to stand? A towel bar is not a grab bar. NIA: mount grab bars near toilets and on both the inside and outside of your tub and shower.
The shopping list is on the Saturday page. Six stops turn "she keeps falling" into six facts her doctor can use.
Is it normal for elderly parents to fall a lot?
Common, yes. Normal in the sense of nothing to do about it, no. NIA's figure is that more than one in four people age 65 or older fall each year, and the risk rises with age. The CDC adds the part that matters for a woman who has already fallen three times: falling once doubles your chances of falling again. So three falls since spring is not bad luck that will average out. It is a pattern, and the same NIA page says many falls can be prevented, naming exercise, managing medications, a vision check and a safer home. Each of those is a doctor's decision or a Saturday's work. None is waiting.
The CDC fact page says fear after a fall may cause a person to cut down on their everyday activities, and when a person is less active, they become weaker and this increases their chances of falling. If she has started holding it until morning, that belongs in the conversation with her doctor too.
If nobody is in the house for the 2am walk, the honest fix is a person, not another night light. New Plan Care, independently owned non-medical in-home care that pays for a labelled slot on this site, sends overnight caregivers in Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific, Valley Park and St. Louis. New Plan Care, Call (314) 405-0887.Paid placement, disclosed on the front page and in the footer.