Bathroom safety; Toilet aides
People with a wide variety of physical and mental impairments may require some modification of the physical environment to improve safe access to the toilet. Bathrooms should be modified to compensate for the person's altered mobility.
Handrails should be placed near the toilet to assist the person in transferring to the toilet. Remove any throw rugs from the bathroom and all corridors leading to the bathroom. Take measures to ensure that proper lighting is available, in both the bathroom and the corridors. Placement of several night lights may ensure that the person safely reaches the bathroom.
Also, some people, especially those with neurological disorders, may become confused upon waking in a dark room. Placement of night lights or motion sensor lights may help to reorient the person to their location.
Special raised toilet seats may be beneficial for people who have difficulty using standard toilet seats (e.g. people who have sustained a hip fracture, or those with arthritis or other musculoskeletal injuries). These items may be purchased from a medical supply company, pharmacy, or hospital supply center. Some insurance companies may cover these devices under the durable medical device provision.
If access to the bathroom requires the person to climb steps or travel large distances, provide the person with a bedside urinal or commode. The commode is a portable toilet that can be placed close to the bed or chair where the person usually resides. The commode should be sturdy and should not slide easily. Adjust the level of the chair so that the person can easily transfer from the bed or chair to the commode.
People who use a walker or wheelchair may need to have their doors and bathroom layout changed to accommodate this equipment. Special attention should be made to the direction that the door opens. Does the door hinder access to the toilet? Are other bathroom fixtures in the way? Is there enough room to use the walker or wheelchair while in the bathroom? A rehabilitation therapist may be helpful in assisting you in determining what modifications are necessary.
If you are caring for someone who needs assistance to use the toilet, developing a call system (such as a bell or buzzer) to alert the caretaker to the needs of the person may be helpful. Often there is little time between the first urge to urinate and an incontinence episode. Therefore, the caretaker must be attentive to the toileting needs of the immobile person.
People with impaired dexterity (such as weakness resulting from stroke, spinal cord injury, or arthritis) may benefit from modifying their clothing so it is easier to manipulate. Consider choosing clothing with a zipper instead of buttons, which may be difficult to manipulate.
Some people have replaced all zippers and button closures on their clothing with Velcro, which is much easier to use. Do not wear too many layers of clothing or underwear, which may be cumbersome to remove. If diapers or containment devices are used, choose devices that are easily removed.
A vocational therapist or rehabilitation therapist can provide you with a list of manufacturers of "ready to wear" clothing and assistive devices.
Assistive Technologies in the Home. Clinics in Geriatric Medicine. Feb 2009;25(1):61-77.
Hou JY, Reger SI, Sahgal V. Durable medical equipment. In: Walsh D, Caraceni AT, Fainsinger R, et al, eds. Palliative Medicine. 1st ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 102.
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine.
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