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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
If an underlying cause is identified then this should be addressed. Contributory factors such as dehydration and immobility should be improved. If the person's diet is believed to contain insufficient fibre, then dietary advice is appropriate (aiming for 20–40 g of fibre per day12). Dried fruits, such as prunes, contain both fibre and sorbitol (a sugar found in plants that acts as an osmotic laxative). Positioning on the toilet can influence bowel emptying. Raising the feet up adopts a more natural defaecation position that helps to open the anal canal. While in hospital, bedpans (terrible positioning) and commodes (would you be happy going behind a curtain?) should be avoided. Patients should be mobilised to the toilet whenever possible, even if hoisting on to the toilet is required. Toileting equipment provision may be helpful (see page 262).
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Incontinence, the involuntary loss of bladder and/or bowel function, is a common symptom associated with the end of life. Unfortunately, falls are also strongly correlated with incontinence, particularly in elderly hospitalized individuals.86 Maintenance of safe functional mobility for the greatest duration possible can also allow individuals the autonomy of independent toileting as long as they are able. Fall risk reduction practices in the presence of incontinence include: the use of night lights; avoiding fluids in the evening after dinner time and before bed; avoiding acidic drinks (cranberry juice, coffee); the use of a regular voiding schedule; and access to a bedside commode and/or urinal. Caution should be taken in patients with visual deficits, altered mental status, and those with prescribed diuretic medications. Gait deviations should be addressed with gait training and the appropriate assistive device to improve safe ambulation during trips for toileting. For patients with early or persistent incontinence, referral to a pelvic floor therapist may be beneficial (see Figure 17.5).
3.00: Personal hygiene
Published in Fiona Broadley, Supporting Life Skills for Young Children with Vision Impairment and Other Disabilities, 2020
Some children find the whole idea of passing a motion frightening and may need specialist support. If the fear is so great that they can only poo in a nappy, go with that for a while. They can still sit on the potty or toilet wearing the nappy, then can progress to laying a nappy across the bowl. Seek professional advice if this fear leads to constipation. As mentioned earlier, some health visitors and school nurses specialise in toileting problems.
Change in care hours, cost, and functional independence following continence and assistive technology intervention in an acquired brain injury population
Published in Disability and Rehabilitation, 2023
Hayley Jackson, Georgina Mann, Angelita Martini, Lakkhina Troeung, Katie Beros, Annelize Prinsloo
Taken as a whole, the act of toileting is complex, requiring a broad range of functions including motor skills, cognitive and perceptual abilities, and physiologic function [5]. More specifically, toileting involves several steps carried out at specific times of the day: mobility to and from the toilet, transferring onto and off the toilet, adjustment of clothing, control of the elimination of waste material from the bladder and bowel, and maintaining appropriate hand and perineal hygiene [14]. Impairments in toileting following ABI are complex due to the multidimensional nature of the injury and can be caused not only by problems relating to the storage and elimination of urine and faeces, but also impairments in mobility, dexterity, and cognitive function [15,16]. For this group, toileting disability often prompts the need for regular intervention from one or more healthcare staff or caregivers and is among the most burdensome and financially costly of care tasks [17].
Wearable gait device for stroke gait rehabilitation at home
Published in Topics in Stroke Rehabilitation, 2021
David Huizenga, Lauren Rashford, Brianne Darcy, Elizabeth Lundin, Ryan Medas, S. Tyler Shultz, Elizabeth DuBose, Kyle B. Reed
The speed of an individual’s gait also relates to their ability to function independently in the home and community. Therefore, gait speed categories are often used to quantify the functional meaningfulness of gait speed improvement.30 In 2007, Schmid et al. investigated if changes in gait classification correlate with improved function and quality of life in stroke survivors.43 Results found that transition to a higher class of ambulation resulted in better function and quality of life, especially for household ambulators.43 This means that the individual may be able to get to the bathroom in time for successful toileting, for example. In our sample, 13/21 (62%) changed to a more functional gait classification.30 Further, of our participants categorized as ‘home ambulators’ at baseline, six out of seven improved from a ‘home ambulator’ to a ‘limited community ambulator.’ This improvement may provide further explanation for the statistically significant improvement in SS-QOL scores.
Prevalence and characteristics of incident falls related to nocturnal toileting in hospitalized patients
Published in Acta Clinica Belgica, 2021
Veerle Decalf, Wendy Bower, Georgie Rose, Mirko Petrovic, Ronny Pieters, Kristof Eeckloo, Karel Everaert
Identification of patients at high risk of falling with a fall risk screening tool is embedded in different falls prevention programs, but the predictive value of these tools remains inadequate, especially in an older population. A periodical clinical assessment to detect individual risk factors is therefore still mandatory [4,5]. Despite the fact that lower urinary tract symptoms are assumed as a risk factor in different falls risk screening tools (e.g. frequency in the St. Thomas’ Risk Assessment Tool in Falling elderly inpatients; urinary incontinence in the Hendrich Fall risk Model; incontinence, urgency and frequency in the John Hopkins Fall Risk Assessment Tool and incontinence in the Schmid Fall Risk Assessment Tool), there is still limited research about the prevalence and associated factors of toileting-related falls in the hospital setting [6–10].