Staying on the Rails of Independence

Sally Madeley-Carr, OT
31 May 2022

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As one gets older, one's body changes and a descriptive way to think of this is that the elasticity of our bones and muscles starts to lose strength and power.

Whilst many people will be able to remain independent throughout their lives, there will also be some who need to look for support to maintain or, indeed, hold on to, a satisfying level of independent self.

Tasks once easily within our grasp become a little more bothersome and items once easy to lift become a little too heavy, or awkward, to lift or move.

Balance and walking, as well as sitting and standing, all become a chore and failing eyesight, as well as a change in hearing capacity, affect our overall confidence to be an independent self.

Help Available

The most common options available to elderly individuals receiving personal and / or physical support with tasks not now comfortably within that individual's range of activities include:

• Residential homes and nursing facilities - whilst help can sometimes come in the form of moving into a care home, most potential individuals opt for remaining in their own home, as comfort will dramatically reduce from own home to care home allocation of personal space.
• Care in one's own home - opting for care within the home may come from social services and delivered by a responsible social care worker being in attendance at particular times of the day, to give support with tasks such as food preparation, help with eating, toileting and also personal care.
• Support from family and friends - another option is that the individual remains in his / her own home, with support being provided by family and / or friends.

It should be noted that, whilst family or friends may seem the better option, receiving this care can sometimes negatively impact the relationship, as the personal title of daughter, husband, grandson or best friend can evolve into that of personal carer.

Trying to Remain Fully Independent for as Long as Possible

With careful monitoring, knowing at what stage an elderly person needs support and for what task(s), special physical aids can help with personal tasks for that individual's needs.

Tasks which may come into question may include ordinary everyday needs, such as washing and ironing, housework, shopping, medical appointments and administration of medicines, preparing and eating healthy food (avoiding snacking), cleaning one's teeth, personal hygiene, bathing and showering, shaving, grooming and toileting.

Onset of Age-related Conditions

Many types of illness or injury can make sitting and standing become monumental tasks.

Asking for help with sitting and standing in any room but the toilet or bathroom is an easy ask, and can provide willing help from the person nearby. The person needing help feels comfortable in asking for support and the supplier of the help is not only happy to help but can also feel good about providing that help.

Asking for help with toileting and personal hygiene needs is more difficult, leaving the asker feeling more vulnerable and viewed as not able to cope. Someone coming forward to offer help is a bigger issue, as it can leave the supplier of that help with a regular task to carry out, thus impacting on their own life diary.

When Support is Needed

The slowing down of physical agility may affect balance, walking, sitting and standing.

Being unable to get to the indoor place you need to reach with ease can affect purpose and mood (e.g. showering becomes a chore and food preparation is reduced to cereal or a sandwich).

Being unable to reach the toilet in time can reduce self-esteem and also lower morale.

The Kitchen and Food for Thought

Moving around a kitchen means that balance is extremely important, as the kitchen can be a dangerous place if you lose balance. Fit grab rails within reaching distance of each other, so as to support the body frame whilst moving around and completing tasks.

Have regularly used items and foods within reaching distance, so as not to cause the need to climb or stretch.

Eat sensibly; healthy food maintains health, self-esteem and morale.

If vision is changing with age, fit spotlights in the right places, to make food preparation and cooking both safe and more pleasing.

The Bathroom and Accessibility

Whilst most homes have an upstairs bathroom and toilet, not all homes have a downstairs loo. Difficulty or slowness with mobility can prove a concern for reaching the toilet in time.

Access difficulties need to be addressed e.g. creating a one storey home, by either bringing the bed downstairs, or taking food preparation facilities upstairs.

For concerns with balance, have grab rails fitted within easy reach of each other, to allow the user to move comfortably within this room.

Fit grab rails at the entrance point (to steady oneself when switching the bathroom light on or off), at the wash hand basin (washing, shaving, cleaning teeth), near the toilet and both inside and outside the bath / shower area.

Fitting one or two grab rails within the shower and bath space can prove invaluable for one's balance when standing in the shower, as well as steadying oneself when getting in and out of the bath.

Other accessories which offer a heightened element of safety in the bathroom include:

• A non-slip bath mat in the bath or shower tray
• A non-slip mat on the floor outside the bathing area
• A bath board, designed to fit across the bath, allowing the user to sit comfortably on the bath board, before swinging one's legs into the bath water
• A drop down shower seat, which is attached to the shower wall
• Water temperature control (ageing skin can sometimes be unaware of extremes of temperature)
• For those with failing eyesight, spotlights directed to the main areas in the bathroom will make privacy a simpler task.

Toileting

Being able to manage toileting independently really is a game changer for people who will accept help with most other tasks.

Weakening muscles and bones, arthritis in joints and the onset of other disabilities (e.g. Parkinson's disease) may make bending at the knee a difficult and painful task.

The purchase of the right disability aids can make toileting a once again achievable task and give the ageing individual safety in the knowledge that he or she can 'still manage'.

Toileting Accessories

The standard toilet comes at the height of 17 inches (42.5 cms.). Higher toilets of 20 inches ((50 cms.) and 21 inches (52.5 cms.) mean that the user does not have to lower his/her body so far and so should find it easier to get up from that heightened sitting position.

An extra thick toilet seat can also give a little elevation, making toileting more comfortable.

A toilet frame for elderly people oozes independence. With all-round support, even the weaker-framed individual can feel safe when alone for this personal task.

Toilet frames are lightweight and the supporting arm height can usually be adjusted, catering for both shorter and taller body frames.

A shower chair with wheels can prove useful, as its frame can fit round the toilet bowl. Some shower chair designs come with a hole cut out of the seat, allowing the user to use this support when using the toilet.

A shower toilet gives the user the comfort of washing and also drying one's bottom, as well as flushing the toilet. For users who find cleaning themselves after toileting an awkward task, this toilet ticks all the boxes.

If accessing the toilet is not an easy task because of mobility reasons, a metal-framed commode chair might be the answer. The seat features a potty container and a lid, making it presentable in any place in the home.

For extra comfort, a cushion for toilet seat and commodes can make sitting more comfortable and also warmer. One cushion will not fit all, so make sure you choose your toilet frame or commode seat, before purchasing the cushion.

Summary

Appropriately placed grab rails will steady the individual when moving around, as well as when sitting down and getting into a standing position.

Toileting habits may change with age (e.g. incontinence) and finding the most suitable toileting aids can make 'being caught short' less of a likelihood.

Purchasing a toilet frame for elderly people is a wise move, as it takes a lot of the worry out of wondering how safe your individual is, when out of your sight.

A cushion for toilet seats gives added comfort, as a cold toilet seat can make one jumpy upon contact with such an extreme temperature.

When purchasing a shower toilet, take note that installation may mean making alterations to the bathroom, to accommodate the toilet + shower system.

When choosing between residential or nursing care, home care, or receiving support from family and friends, it must not be forgotten that a very important element of quality of life is social interaction with others. An important point to therefore address is whether quality of life will still be maintained within the option chosen.