Making the Bathroom Safer and More Manageable for Elderly People

Sally Madeley-Carr, OT
20 Aug 2021

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As is with the kitchen, the bathroom is classified as one of the most dangerous rooms in the house.

Eighty one percent of accidents in the bathroom are as a result of falls.

Falls can be due to wet or slippery floors, slipping on or tripping over mats, objects or furniture causing obstructions and also because of health problems e.g. fainting, dizziness, changing eyesight and changes in mobility.

In later years, senior people with health conditions may need adaptations and specialist equipment in the bathroom. These needs may be as a result of weakening grip, balance problems, mobility difficulties, sight deterioration, arthritis, lack of confidence and many other age-related changes in health.

Falls

Whilst a young adult may be able to withstand a fall, the more elderly person may break bones, receive a more significant blow to the head due to less agility and grip to save oneself from the fall and be more likely to suffer from shock and its sometimes severe consequences.

The most common causes of falls are wet and slippery floors, shiny tiled surfaces which offer reduced safety and mats that may move underfoot.

Falls can happen in the bathroom itself, as well as within the bath or shower.

Bathroom floor surfaces are most often tiled. Pay attention to the tile finish i.e. a matt or stone finish is safer than the shiny tile, as spilt water is less likely to cause slipping on the rougher surface.

Small mats on that same shiny surface can slide under one's feet and cause a bad fall.

Always check that the mat you want to purchase has a non-slip underside.

Addressing the flooring in a bathroom will be a major factor in preventing falls.

Steadying Oneself In and Out of the Shower / Bath

When you're unsteady on your feet, getting in and out of a bath has its own dangers. Getting one leg out and onto the floor can unbalance the individual and lead to a fall.

For walk in showers, a shower chair gives the user better balance in the sitting position and will help avoid falls from any weakness in the legs.

For wheelchair users, a wet room is the ideal situation, as there is no step to mount upon entrance.

A shower chair on wheels can be used to enter the wet room and can also be used to move around the bathroom.

A shower chair with lockable wheels adds more safety to bathing alone.

For people who are unsteady on their feet, a bath board can make it a lot easier to get into the bath. With the bath board fixed to the top of the bath, the procedure is to:-

• sit on the bath board, with your legs still on the floor
• turn and move towards getting your feet into the bath
• edge along on the bath board, to be within the bath tub space itself
• with the use of grab rails, ease yourself into the water
• reverse the procedure for getting out of the water.

A specifically-designed grab handle can be fixed to the bath board (at the side furthest from entry into the bath), or a grab rail can be attached to the wall at the appropriate position, to make entering and leaving the bath a less worrying feat.

A non slip bath mat which attaches itself to the bath base or shower base via suckers can be a lifesaver. For those who can stand in the shower, or for climbing into the bath, the non slip bath mat gives you a safe base to stand on, builds user confidence and also steadies the individual when climbing out of the bath / shower.

Toilet Height

The standard height for a toilet tends to be around 17 inches (42.5 cms.).

Age brings with it a weaker body frame, which makes sitting down and standing up appear a challenge. Altering the height of the toilet can make these manoeuvres easier and safer.

A height of 20 inches (50 cms.) to 21 inches (55 cms.) proves safer for seniors, as stooping is reduced and the distance to regain full upright posture is also reduced.

Extra toilet height can also be accomplished by fitting a thicker toilet seat.

A toilet booster seat can also be easily clipped to the original toilet seat and add up to four inches (10 cms.) to the overall height of the toilet.

Booster seats are easily detachable for cleaning and also for using the toilet at its regular height.

Some shower chairs with wheels are also designed to be positioned over the toilet. With a horseshoe aperture cut out of the shower seat, using the toilet can be done from there.

Changes to Eyesight

Ageing eyes make reading glasses a common need amongst elderly people but age also brings other changes to eyesight (e.g. macular degeneration, glaucoma, clouded vision, loss of peripheral vision and loss of three-dimensional vision).

Changes in eyesight create a need to adapt to new circumstances, in order to support residual vision for the task in hand.

Identifying the exact location of light switches, and maybe dropping them to a more accessible height, can be supported by lighting being directed towards them.

Bright lights will not necessarily be the right choice for someone with a visual impairment. Choosing calmer lighting may prove more appropriate, as well as more soothing.

Larger light switches, as well as strongly coloured switches, will prove more identifiable.

Brightly coloured towels which don't blend into the wall colouring will help the individual locate the towels more swiftly.

For personal grooming, a magnified mirror might prove useful e.g. shaving, cleaning your teeth and applying make-up.

Other Safety Concerns

A fall could lead to the individual bumping his / her head or upper body against a bathroom fixture. Look for wash hand basins and cabinets with rounded corners, instead of sharp ones, to lessen the chance of broken skin causing bleeding.

Fit grab rails in appropriate places (you can't have too many), to give mobility security to the individual when moving around in the bathroom, or even when standing still e.g. to clean one's teeth.

Appropriate places for grab rails include entry into the bathroom, near the toilet, outside the shower / bath, inside the shower / bath and at the wash hand basin.

Grab rails can be fitted horizontally, diagonally and vertically, available space or the task in hand maybe dictating the best position to employ.

Give serious thought to storage in your bathroom. Keep regularly used items at arm's length, avoiding any need for the elderly person to have to stretch or stoop to reach what is needed.

Slide doors, or even no doors at all, may be more appropriate on bathroom cupboards, as opening and closing doors sometimes involves stepping back, to give room to the door.

Whilst the individual in the bathroom will wish to lock the bathroom door for privacy reasons, a double-sided lock can ensure quick entry into the bathroom in emergency situations.

Medication as well as ageing can cause neurological damage to the skin, leaving the person unable to register that water temperatures may be far too hot for them. An ideal temperature for bathing is around 45 C / 113 F and anything hotter could lead to serious burns and scalds.

Getting the right, preset, temperature for bathroom taps is a safe way of reducing the risk of burns or scalds. A mixer tap also has an advantage over two taps, as achieving a safe temperature involves using only one hand.

If the bathroom door is not wide enough for a wheelchair to enter, transferring to a shower chair with wheels for entry, and for moving around in the bathroom, could be the answer.

Choose grab-style handles for cupboards and drawers rather than knobs, as these can also serve as grab rails for holding onto.

Mirror height may need to be adjusted for those working from a wheelchair or shower chair, as standing up to use a mirror at a regular height could lead to a fall.

Summary

Even a slight change can make a big difference.

Non-slip flooring in a bathroom will be a positive measure in preventing falls.

For a shower over a bath, two grab rails at different heights will be needed, one for getting out of the bath, the other for standing up in the shower and for getting out.

A shower chair with lockable wheels will prove much safer than a shower chair without locks on the wheels.

Sliding doors on cupboards will make access both easier and safer.

Contrasting colours and also light direction will help people with visual changes navigate and locate with more ease.

NB - Please note that, stepping into a temperature which is at the extremes (very cold or very hot) will cause the user to jerk backwards, so having the right temperature ready to step into is a major factor in safety in the bath or shower.