Written by Daniel Arias Ruiz, Chartered Physiotherapist (MSc), HCPC registered
Last reviewed 10 October 2026 · 4 min read
An essential check I carry out at every home visit assessment is how the person gets from their bed to the toilet at night. The reason is not always obvious to people, it usually gets a puzzled look. So, I am writing this blog to explain the reasoning and the importance behind it.
As you get older, needing the toilet at night becomes a frequent occurrence (Bosch and Weiss, 2010). The route someone takes in the middle of the night has more hazards than the journey they take in the middle of the day. The lights are off, they have just woken up, they may be in a hurry, they are often on their own. These are things healthcare professionals do not see in a clinic room, which is why a home visit is important.
Why the route matters more than a checklist
There is a good amount of research to show that changing things in the home reduces falls risk. A 2023 Cochrane review of older people living in the community found that identifying and changing home hazards cut the rate of falls by 38% in those identified as higher risk of falling (9 studies, 1,513 people, high-certainty evidence). For those people who had not been identified as higher risk, the same changes made no difference (6 studies, 3,780 people, high-certainty evidence).
The second finding is as important as the first. What I take from this is that handing everyone the same generic checklist does not work. The check has to be tailored to each person, their home, their habits and how they move.
The 2025 NICE guidelines on falls assessment and prevention in older people suggest having a home hazard assessment and intervention carried out by an occupational therapist or an appropriately trained healthcare professional (recommendation 1.3.6).
These are published research findings, not guaranteed results of our service.
Six things I look at
1. Light
Can they switch the light on before they get out of bed? Having a lamp or a switch they can reach from the bed changes the first few steps of the journey.
2. The path
Are there any hazards between the bed and the toilet? Things like rugs, cables, door thresholds or a laundry basket. I walk the route with them and scan for hazards on the floor as well as furniture along the way.
3. Handholds
What do they hold on to along the way? It's often whatever is near, such as a chair that slides, a door that swings, a drying rack. I make a note of what they hold on to, because those things are not designed to take someone's weight.
4. Getting up
Can they roll independently in bed? How do they go from lying down in bed to standing when they are half asleep? Do they sit on the edge of the bed for a moment or stand up straight away?
5. Feet
Do they walk barefoot or wear slippers or socks? Whatever they wear at night, I look at how it grips on the floor, including the changes from carpet to tiles.
6. Distance and time
How far is the toilet from the bed and how quickly can they get there? Are they able to complete the full journey in one go or do they need a seated rest? A long route with a sense of urgency is different from a short route at a calm pace.
What happens after the check
The findings of my assessment go into their written report and their programme. Any changes are agreed with the person because it is their home and changes they don't want don't usually last.
If there are equipment or adaptation needs, I would refer to an occupational therapist.
To see what a full home visit involves, read our guide to home physiotherapy for older adults.
Every recovery is different.
Sources
Clemson L, et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2023, CD013258.
NICE guideline NG249. Falls: assessment and prevention in older people and in people 50 and over at higher risk. 29 April 2025.
Bosch JLHR, Weiss JP. The prevalence and causes of nocturia. Journal of Urology 2010;184(2):440-446.
Worried about a parent's night time trips?
If you are worried someone you care for might have a fall at night, we are happy to talk it through on a free 15 minute call with Daniel. No obligation, and a relative can book on someone's behalf.
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