Raised Toilet Seats Research Articles

A survey on the availability of geriatric-friendly protocols, equipment and physical environment across emergency departments in Flanders, Belgium

BackgroundThe acquisition of geriatric-friendly resources is an important part of adapting emergency department (ED) care to the needs of vulnerable older patients. The aim of this study was to explore the availability of geriatric-friendly protocols, equipment and physical environment criteria in EDs and to identify related improvement opportunities.MethodsThe head nurse of 63 EDs in Flanders and Brussels Capital Region was invited to complete a survey in collaboration with the chief physician of the ED. The questionnaire was inspired by the American College of Emergency Physicians Geriatric ED Accreditation Program and explored the availability, relevance and feasibility of geriatric-friendly protocols, equipment and physical environment. Descriptive analyses were performed. A region-wide improvement opportunity was defined as a resource that was never to occasionally (0–50%) available on Flemish EDs and was scored (rather or very) relevant by at least 75% of respondents.ResultsA total of 32 questionnaires were analysed. The response rate was 50.8%. All surveyed resources were available in at least one ED. Eighteen out of 52 resources (34.6%) were available in more than half of EDs. Ten region-wide improvement opportunities were identified. These comprised seven protocols and three physical environment characteristics: 1) a geriatric approach initiated from physical triage, 2) elder abuse, 3) discharge to residential facility, 4) frequent geriatric pathologies, 5) access to geriatric specific follow-up clinics, 6) medication reconciliation, 7) minimising ‘nihil per os’ designation, 8) a large-face, analogue clock in each patient room, 9) raised toilet seats and 10) non-slip floors.ConclusionsCurrently available resources supporting optimal ED care for older patients in Flanders are very heterogeneous. Researchers, clinicians and policy makers need to define which geriatric-friendly protocols, equipment and physical environment criteria should become region-wide minimum operational standards. Findings of this study are relevant to facilitate the development process of this endeavour.

Clinical Presentation of Varicose Veins

Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. Evidence of surgical intervention was found in the 1860s. However dramatic advances of varicose vein management occurred in the latter half of twentieth century. Varicose veins affect from 40 to 60% of women and 15 to 30% men. Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are considered to be the predisposing factors for formation of varicose vein. Other reported factors are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives. Common symptoms are unsightly visible veins, pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, and bleeding. The signs of varicose vein disease are edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), and atrophie blanche. Varicose vein is classified according to CEAP classification, the components of which are clinical, etiological, anatomy, and pathophysiology. The revised CEAP classification was published on 2020 based on four principles which were preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based medicine, and practicality.

Unmet Needs for Equipment to Help with Bathing and Toileting Among U.S. Older Adults

Using adapted toileting and bathing equipment, such as raised toilet seats, shower seats, and grab bars, prevents injuries and falls in older adults.

Unmet Need for Equipment to Help With Bathing and Toileting Among Older US Adults

Home modification through seemingly mundane equipment, such as grab bars and shower seats, mitigates injury, dependence, and reduced quality of life in older adults coping with increasing disability. However, whether these interventions are underused in the US is unclear. To estimate how many older adults who need equipment to help with bathing and toileting do not have it, describe factors associated with not having equipment, and describe how many who did not initially have equipment acquired equipment over time. This observational cohort study of participants 65 years or older used secondary data from the 2015 to 2019 waves of the US National Health and Aging Trends Study. Participants included community-dwelling older adults who would unequivocally benefit from equipment, defined as those with poor physical performance or substantial difficulty bathing, toileting, transferring, or walking. Respondents were representative of the US population 65 years and older. Data were collected from May 2015 to October 2019 and analyzed from August 1, 2019, to February 24, 2021. Population characteristics (eg, age, sex, income, health conditions, and physical performance), environmental factors (eg, home ownership and living arrangement), and health behaviors (eg, prior knee and/or hip surgery). Prevalence of any unmet need for equipment, defined as either needing bathing equipment (bath grab bars and shower seat) but having none or needing toileting equipment (toilet grab bars and raised toilet seat) but having none and the cumulative incidence of equipment acquisition during 4 years of follow-up. A total of 2614 participants representing 12 million US individuals would benefit from equipment. The mean (SD) age was 80.5 (8.2) years, and 1619 individuals (62%) were women. Of these, an estimated 5 million individuals (42%; 95% CI, 39%-44%) had an unmet need. After adjustment for age, sex, and race/ethnicity, unmet need was associated with younger age (49% if aged 65-74 years, 37% if aged 75-84 years, and 29% if aged ≥85 years; P < .001), having fewer health conditions (55% if none vs 39% if ≥3; P = .002), non-White race/ethnicity (40% if White vs 51% if Black, 54% if Hispanic, and 55% if other; P < .001), no recent hospitalization (46% vs 37% if hospitalized; P = .001), and no prior knee and/or hip fracture or surgery (46% vs 35% if prior fracture or surgery; P < .001). After 4 years of follow-up, 35% of those with bathing equipment needs and 52% of those with toileting equipment needs never received equipment. This cohort study suggests that in the US, 42% of older adults with impairments that would make bathing or toileting difficult lack equipment to assist. This situation is a missed opportunity to help 5 million individuals live independently and safely.

A Protocol of Pose Avoidance in Place of Hip Precautions After Posterior-Approach Total Hip Arthroplasty May Not Increase Risk of Post-operative Dislocation.

Post-operative rehabilitation after posterior-approach total hip arthroplasty (P-THA) includes the use of standard hip precautions, defined as no hip flexion beyond 90°, hip adduction, or hip internal rotation for 6 to 12weeks after surgery (sometimes for life). Since they were first implemented in the 1970s, subsequent advances may have made standard hipprecautions no longer necessary, although little evidence supports that hypothesis. A modified set of precautions, a "pose avoidance protocol," could be effective in enhancing recovery, but its effectiveness on early dislocation and post-surgical outcomes is not known. We sought to determine the functional recovery of patients on a pose avoidance protocol after P-THA according to levels of pain and patient satisfaction, rates of dislocation, the use of assistive devices, and a return to driving. We conducted a retrospective, descriptive study of data from a consecutive case series of 164 patients treated by a single surgeon between January 2014 and December 2015. Patients whohad undergone a primary uncemented P-THA were prescribed a pose avoidance protocol and followed for a minimum of 6weeks. Exclusion criteria were patients with congenital hip dysplasia, revision THA, femoral neck fracture, rheumatoid arthritis, or neuromuscular disease. Changes to the rehabilitation protocol included elimination of the requirements to use elevated chairs, raised toilet seats, and abduction pillows for sleeping. Patients couldresume driving at 2 and 3weeks for left and right P-THA, respectively. The only motion restriction was avoiding the combination of hip flexion past 90°, hip adduction, and hip internal rotation. Patients could perform all other movements and to bear weight and stop using walking aids as tolerated. Patients completed a biweekly questionnaire to assess their functional recovery, opioid use, and pain levels. At 2weeks after surgery, 80% of patients reported no pain, 86% did not require walking aids, and 92% were satisfied with their recovery. At 6weeks after surgery, 89% of patients reported no pain. Patients returned to driving at a mean of 2.7weeks after surgery. No patients had experienced a dislocation at 6weeks of follow-up. A pose avoidance rehabilitation protocol in this P-THA population was found to be safe and was associated with accelerated functional recovery and high patient satisfaction without increased risk of early post-operative dislocation.

Post-discharge use of assistive devices following hemiarthroplasty: comparison of fracture patients with or without hip precautions

Purpose: To describe which types of assistive devices prescribed and actually used, either due to precautions or due to true functional reasons, after hip fracture-related hemiarthroplasty.Materials and methods: About 394 patients cluster-randomized 2010–2014 at a university hospital. Control group with standard postoperative precautions to reduce dislocations, mandatory assistive devices and knee brace for 6 weeks (in cognitively impaired) compared to non-precaution group with assistive devices only if needed. Postal questionnaire at 6 weeks and 3 months.Results: Both prescription and usage of reacher were higher in the precaution group. About 55% of patients with precautions was instructed to use stocking aids, 21% continued to do so. Significantly fewer without precautions, 11%, used it at 3 months. Raised toilet seat was used by ∼40% of all pre-fracture and was prescribed to 79% with precautions. It was unchanged at 42% in non-precaution group. Nevertheless, 64% in non-precaution group used a raised toilet both at 6 weeks and 3 months. The usage persisted around 70% in precaution group. Usage of raised chair/bed were similar, even if non-precaution patients was not prescribed such. In the precaution group, 102 were prescribed a knee brace, only 5 used it at 6 weeks.Conclusions: The use of assistive devices did not follow what was prescribed from the hospital, regardless of precautions or not. The use of higher furniture was similar regardless of precautions or not. Other devices were more common in the precaution group. The compliance of knee bracing was low, and bracing should not be standard-of-care.Implications for rehabilitationHemiarthroplasty is the most common treatment of displaced femoral neck fracture in elderly. Dislocation occur in 2 to 10% of these patients, and traditionally patients have been instructed to be careful when moving their leg and to use a number of assistive devices, in order to reduce the dislocation risk.The evidence base for such precautions is weak and occupational therapy and assistive devices may be costly. The current study shows that prescriptions and instructions from occupational therapists in hospital is more or less not follow after dismissal.Assistive devices should be prescribed based on the hip fracture patient’s true functional needs, and not routinely or due to arthroplasty precautions.

Measurement of Fall Prevention Awareness and Behaviours among Older Adults at Home.

This study surveyed awareness of, and adherence to, six national fall prevention recommendations among community-dwelling older adults (n = 1050) in Ottawa. Although 76 per cent of respondents agreed falling is a concern and preventable, fewer perceived susceptibility to falling (63%). Respondents had high awareness that home modifications and physical activity can prevent falls. Reported modifications included grab bars (50%), night lights (44%), and raised toilet seats (19%). Half met aerobic activity recommendations; 38 per cent met strength recommendations. Respondents had lower awareness that an annual medication review, annual eye and physical examination, and daily vitamin D supplementation could reduce fall risk. However, reported annual medication review (79%) and eye examination (75%) was high. Nearly half met recommendations for vitamin D intake. These findings suggest a gap in knowledge of awareness and adherence to national recommendations, highlighting the ones that may require attention from those who work to prevent falls.

Variation in the Presence of Simple Home Modifications of Older Americans: Findings from the National Health and Aging Trends Study.

To investigate the association between sociodemographic and economic factors and the presence of simple home modifications (HMs) among older adults in the United States. Cross-sectional. National Health and Aging Trends Study (2011, Round 1). Community-dwelling Medicare enrollees aged 65 and older (N = 6,628). The primary dependent variable was the reported presence or absence of simple HMs (grab bars in the shower or near the toilet, shower seats, raised toilet seats). Of the individuals sampled, 60.7% reported having at least one HM of interest. Black (odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.68-0.91) and Hispanic (OR = 0.60, 95% CI = 0.45-0.78) respondents were less likely than white, non-Hispanic respondents to have HMs. Those with more education (high school graduate: OR = 1.20, 95% CI = 1.01-1.42; >high school: OR = 1.36, 95% CI = 1.14-1.62) and larger social networks (≥4 people; OR = 1.46, 95% CI = 1.12-1.89) were more likely to have at least one HM, whereas being divorced (OR = 0.57, 95% CI = 0.43-0.74) was associated with lower likelihood. Income (OR = 1.01, 95% CI = 0.97-1.05), Medicaid enrollment (OR = 0.98, 95% CI = 0.77-1.25), and living alone (OR = 1.02, 95% CI = 0.85-1.23) were not significantly associated with the presence of HMs. Minorities, individuals with less education, and those with less social support are less likely to have HMs. Awareness of these disparities and the shortcomings of the HM delivery system is important to clinicians and policy-makers who seek to prevent falls and facilitate aging in place for all older Americans.

Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty.

Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty.

UK survey of occupational therapist’s and physiotherapist’s experiences and attitudes towards hip replacement precautions and equipment

BackgroundTotal hip replacement (THR) is one of the most common orthopaedic procedures in the United Kingdom (UK). Historically, people following THR have been provided with hip precautions and equipment such as: raised toilet seats and furniture rises, in order to reduce the risks of dislocation post-operation. The purpose of this study was to determine current practices in the provision of these interventions in the UK for people following primary THR.MethodsA 27-question, self-administered online survey was developed and distributed to UK physiotherapists and occupational therapists involved in the management of people following primary THR (target respondents). The survey included questions regarding the current practices in the provision of equipment and hip precautions for THR patients, and physiotherapist’s and occupational therapist’s attitudes towards these practices. The survey was disseminated through print and web-based/social media channels.Results170 health professionals (87 physiotherapists and 83 occupational therapists), responded to the survey. Commonly prescribed equipment in respondent’s health trusts were raised toilet seats (95 %), toilet frames and rails (88 %), furniture raises (79 %), helping hands/grabbers (77 %), perching stools (75 %) and long-handled shoe horns (75 %). Hip precautions were routinely prescribed by 97 % of respondents. Hip precautions were most frequently taught in a pre-operative group (52 % of respondents). Similarly equipment was most frequently provided pre-operatively (61 % respondents), and most commonly by occupational therapists (74 % respondents). There was variability in the advice provided on the duration of hip precautions and equipment from up to 6 weeks post-operatively to life-time usage.ConclusionsCurrent practice on hip precautions and provision of equipment is not full representative of clinician’s perceptions of best care after THR. Future research is warranted to determine whether and to whom hip precautions and equipment should be prescribed post-THR as opposed to the current ‘blanket’ provision of equipment and movement restriction provided in UK practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1092-x) contains supplementary material, which is available to authorized users.

Intervention and Documentation Reduce Exposure From Falls

Intervention and Documentation Reduce Exposure From Falls

Postoperatives Management nach Hüft- und Knieendoprothetik

Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.

Specialised environments to meet the needs of older people.

As more people are cared for in the community an increasing proportion of those admitted to hospital can be categorised as frail. This encompasses key clinical syndromes recognised by geriatricians as the 'bread and butter' of geriatric medicine, namely; loss of mobility; falls; confusion; incontinence and polypharmacy. Older hospital inpatients showing these signs of frailty are at particular risk of adverse outcomes such as death or institutionalisation. Modern general hospitals may contribute to this with their technological focus. If acute hospital admission is unavoidable, processes can be adjusted to lessen the impact on the frail older person. They need a comprehensive assessment with a more broad-based diagnostic/therapeutic approach to care than younger patients. Physical environments can also be adjusted with a need for safe flooring, safe wandering space, orientation cues such as large clocks and calendars and aids to mobility such as hand rails and raised toilet seats.

Do we need special measures to promote continence?

It is proposed that in nursing and residential care homes, communal and ensuite toilet doors are boldly identified with both large print and pictorial identification and that aids such as raised toilet seats are provided as standard. Is this a good idea?

Total Hip Replacement: An Audit of the Provision and Use of Equipment

Historically, Perth and Kinross Social Services supplied every total hip replacement patient with a ‘hip pack’ containing a raised toilet seat, a helping hand, a long-handled shoe horn and a sock/tights aid. This pack was issued by the hospital occupational therapist prior to discharge. In January 1996 the funding for this equipment was withdrawn. This move obstructed the hospital-based occupational therapists from achieving the standard practice that ‘all patients will be provided with a hip pack prior to discharge’. The hip pack should be used for 6–12 weeks postoperatively to reduce the risk of dislocation. These standards are in agreement with guidelines in James (1992). The occupational therapy department was concerned that patients would be at greater risk of dislocation if this equipment was not provided. A variety of options were considered to overcome this, including patients purchasing their own equipment or the hospital trust funding a loan service. In order to support these proposals an audit was carried out with three main aims: (i) to assess whether the hospital occupational therapists were meeting the standards by providing every total hip replacement patient with equipment from a hip pack; (ii) to assess whether the standard statement that the hip pack equipment should be used for 6–12 weeks was an appropriate time scale for patients; and (iii) to obtain the patient's perspective on the proposals being explored to continue to meet the standards. There was an 85% (63/74) response rate and the results of the audit highlighted how important the equipment was to the patient. The time each item was used for varied, but many were still in use 6 months postoperatively. Due to budget constraints, patients were also asked if they would purchase some of the equipment; 51 (93%) of the 55 respondents stated that they would have purchased at least one item in the hip pack. The standards were nearly but not fully met. This was due to the lack of flexibility in the standards not acknowledging that some patients would not need equipment.

The Role of Individuals with Mobility Limitations, Family Members, and Helping Agencies in Obtaining Accessible Home Modifications

Home modifications can enhance the independent living of older adults with mobility limitations; however, obtaining modifications to make the home more accessible often requires resources beyond those of the mobility-limited resident. Personal interviews with independently-living adults with mobility limitations were completed to determine who was responsible for the accessibility modifications present in their homes. Forty-six respondents in two rural counties in North Carolina answered questions concerning who identified the need for the modifications, who financed or provided materials, and who provided the labor. The majority of the respondents were limited-income elderly females. Of seven modifications reported by at least five respondents (grab bars, entry ramp, stools/seats of shower or tub, commodes, hand-held showers, raised toilet seats, and walk-in/roll-in showers), the need was most often identified by someone other than the individual with the mobility limitation. The source of financing of the most costly home modification features (entry ramps, new toilets, and walk-in/roll-in showers) was typically someone outside the family, while family members provided the less expensive items (hand-held showers, showertub seats and stools, and grab bars). The majority of the labor was provided by third parties, and the provision of labor and materials was generally by non-family sources. Agencies in the two counties that provided home modification assistance expressed concern that individuals with mobility limitations underutilized available services. The findings suggest that promoting the use of accessible home modifications involves creating a greater awareness of both funding opportunities and modification options for individuals with mobility limitations and their family members.

Combined toilets and bidets for use by people with a disability

Toileting is a function that most people take for granted. However, if considered, it is the activity that causes most embarrassment and distress if assistance is needed. Many people who experience difficulties with toileting find that equipment such as a raised toilet seat or hand rail can restore independence, but where disability is more severe, more complex solutions are required.

Locomotor disability in very elderly people: value of a programme for screening and provision of aids for daily living.

To assess the prevalence of potentially reversible locomotor disabilities in elderly subjects and the cost effectiveness of providing aids for daily living. Population based randomised controlled trial of subjects aged greater than or equal to 85 living independently in an inner London borough. 21 Electoral wards of the London Borough of Hackney. 1255 Subjects aged greater than or equal to 85 living in their own home whose names were obtained from general practitioner lists and cross checked against the electoral register, 511 of whom were subsequently found to be ineligible. Of the 744 remaining, those with disability on screening were randomised and allocated to an intervention group (36) or a control group (43), in which intervention was postponed until four weeks, after the follow up assessment. Subjects with aids supplied previously were excluded from the intervention phase. Provision of raised toilet seat, teapot tipper, tap turner, shoe horn and elastic laces, and double handled saucepan. Degree of difficulty (grades 1-4) with specific tasks (getting on and off a toilet, pouring from a teapot into a cup, turning taps on and off, carrying a saucepan of standard weight, and putting on shoes) and time taken to perform them. 545 (73%) Of the 744 eligible subjects assessed; 428 had no disability and 118 had difficulty with at least one task. Some had had their disability recognised before the study and already had aids, representing half of those with difficulty getting on and off the toilet but 24% for putting on shoes and 13% for pouring from a teapot and turning on a tap. The mean number of difficulties was similar between the groups (intervention group 1.7, control group 1.6). Time taken to complete the tasks corresponded with the observed grade of difficulty. All aids were associated with reduced difficulty according to observer assessment (% improvement intervention group v control group: raised toilet seat, 71 v 13 teapot tipper 100 v 33; tap turner 100 v 0; saucepan 88 v 0; shoe horn 50 v 13) and time taken to complete the tasks. A cost benefit analysis of this screening-intervention programme suggested a total cost of 32 pounds per individual benefit. Appreciable degrees of unrecognised locomotor disability are detected on screening of very elderly people living independently. Providing aids offers a feasible and cost effective means of improving function in such people.

The Use and Effectiveness of Assistive Devices Possessed by Patients Seen in Home Care

The use and effectiveness of 54 selected assistive devices were studied in 30 recipients of home care services. Of these 54 devices, 82% were used and 69% were used routinely for the intended purpose. Twenty patients had bedside commodes and nine had bathtub benches or shower chairs. Only a few patients had long-handled shoe horns, reachers, raised toilet seats, sock aids, elastic shoelaces, commode armrests, or long-handled scrub sponges. No patient had a rocker knife, even though stroke was the most common medical condition. Device training, done inconsistently, generally took 30 minutes or less, spanned 1 to 2 sessions, occurred within 6 months of impairment or 1 year after onset, was carried out by a home health agency, and was judged adequate by the patient. Family members were as apt as not to be included in the training. No association was discerned between training and usage or timing of training in relation to length of impairment and usage. A substantive amount of human help was needed to complete the tasks involving the device. Device disuse was attributed to functional improvement, misprescription, and ineffectiveness.

Modified Raised Toilet Seat

Modified Raised Toilet Seat