however, unless there is a powerful pump for drainage, the older adult will be stuck in rapidly cooling water waiting for it to drain before being able to open the door. The doors also might leak. Unfortunately, some people may not be able to afford the tub removal for a walk-in shower. The old-fashioned steel tubs can be costly and time consuming to remove. Other shower options are built-in benches to sit on, handheld showerheads, and ensuring skid-resistant flooring. A shower arm holder can be purchased at a minimal price to lower and hold the shower head within reach of a seated person. These can be attached to the wall with hardware, permanent adhesive, or suction. Toilets are another area of concern for older adults. Comfort- height toilets should be used; they are higher than the average commode at 16.5” high, and assist in sit-to-stand transfers. Bidet and personal hygiene seats should also be considered; they make toileting hygiene easier and also can help prevent urinary tract infections. Elongated toilet seats also can make access to various body parts easier for better hygiene. The toilet is often situated next to bathtubs and sinks, with no area to place a bar, or the wall has a toilet paper holder where a grab bar should be. During remodeling, the toilet should be moved or arranged so that a wall is available for a grab bar, if possible. Otherwise, flip-up grab bars or toilet seat rails are options. The angle of grab bars around the toilet depends on preference. Slanted bars are useful for transfers when slanting down toward the commode, but are not as useful for stabilization with clothing management. Straight bars are better for clothing management but may place the person’s arm in an uncomfortable position during transfers. There exists a bar that combines a slanted portion for transferring and a horizontal portion for stabilization during clothing management to address this problem. A special note on bathrooms for people with dementia: these are very confusing environments for these people. Bathrooms are often cold and wet. People can become startled and uncomfortable, which is the cause of many showering- and toileting-related outbursts. Warming the room up, having good lighting, and using contrast can help mitigate these behaviors. Heated floors, bathroom heaters, and heated toilet seats reduce agitation and confusion from a sudden touch of cold. Handheld showerheads allow the person to have some control over the water and bring the water down into his or her visual field, which is slowly lowering through the disease process. Use of good contrast will help older adults with dementia discriminate features, such as the toilet, sink, and bathtub against floors and countertops. A light should also be installed in the shower or bathtub so the person can better see the environment. This use of contrast and lighting also helps people with low vision complete hygiene tasks. and also eliminate the need to reach far into the cabinet. For high areas, pulldown shelves may be an option, but these reduce some storage space to have room for the pulldown mechanisms. Open shelving is a modern concept that reduces the need to manipulate cabinets and drawers; many options are available in the local hardware stores, and they can be installed at custom heights. Cabinets under the sink should be considered for removal for future wheelchair access or seated sink use. Finally, exchanging knob handles for larger D handles or pulls makes opening cabinets and drawers easier on hands. In Figure 7, all the shelves in the cabinets of this kitchen pull out for easy and safe item retrieval. It also has a pantry only 6” deep, which prevents the need for reaching and helps decrease difficulty in locating objects. This kitchen has a drawer under the stove to store pots and pans in a more convenient location (not shown).
wet environment, and use of mobility devices in a sometimes- small area. Use of matte tiles and counters helps reduce the glare and discomfort for people with low vision and age-related visual changes. Replacing faucet knobs with lever faucets eliminates difficulty with controlling water at the sink and in the shower. A 5′ by 5′ turning radius is suggested for people in wheelchairs to be able to access various points of the bathroom properly. In a remodeling or design process, ensuring proper space and turning radiuses will save the homeowner problems accessing the room in the future. Grab bars greatly reduce the risk of falling. Placement is important; an improperly placed grab bar will not help the older adult with transfers. Contrary to popular belief, grab bars should not be placed in studs. According to contractors, grab bars may damage the stud. Stud finders can locate the stud, but do not inform the installer of which part of the stud has been located. Therefore, the bar may end up being installed at the edge, versus the middle, of the wood. The condition of the stud wood cannot be verified without opening the wall, so any water damage inside the wall would compromise the integrity of the grab bar installation. Additionally, electrical wires and plumbing run close to studs. Plumbing has changed from copper to PVC pipes. The heat generated from a drill may damage the PVC pipe, resulting in a leak with water damage to the wall. Therefore, a good contractor will use a radar gun to determine items behind the wall, and will install away from studs. Blocking in the wall during remodeling projects helps reinforce the wall for future grab bars; suggest that the homeowner take pictures of the blocking as documentation of the location. Contractors should also use fastener hardware that self-reinforces the wall and can withstand a pull force of at least 250 pounds. With grab bar choices, they come in many different colors and styles to suit the aesthetics of the older adult. It is also possible to have them custom powder coated at a local auto body shop for specific colors. When choosing a bar, a 1.5” or mid-sized diameter bar typically feels most comfortable to older adults (Kong & Lowe, 2005). They should be etched as a slip-resistant feature in a wet environment, but the roughness should be taken into consideration due to the fragility of older adults’ skin. Research has found the most preferred location for grab bars around the bathtub is a horizontal bar along the back wall and a vertical bar along the adjacent wall where the person would enter (Guitard, Sveistrup, Edwards, & Lockett, 2011). However, the clinician should always take into consideration the client’s preferences and current hand placements when completing a tub transfer to determine the optimal placement for that person. For people with the means, replacing the tub with a walk-in shower is ideal. Eliminating the high tub lip removes a large barrier to showering. Walk-in tubs seem to be a great idea; Kitchen The kitchen is the heart of a home. It is also an area that can quickly become inaccessible to an older adult. Pain, vision problems, and decreased balance, range of motion, and strength all play a role in impacting someone’s meal-preparation abilities. Cabinets, countertops, appliances, and lighting are all specific areas of concern. People may find themselves unable to reach into their cabinets for a variety of reasons, such as increased shoulder pain, decreased upper extremity range of motion, decreased posture, the introduction of mobility devices, and risk of possible loss of balance with overhead reaching. Pain in the hands also affects obtaining objects. Solutions include installation of a lazy Susan in corner cabinets to bring back items to the front. There are multiple versions and configurations of pullout drawers and shelves for cabinets of all sizes. Instead of drawers, a pullout cabinet can be installed; these are accessible from both sides
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