Bedroom The most common challenges related to the bedroom are navigating to the bathroom from bed at night, using light switches, and clothing management in closets. Due to medication side effects or incontinence, older adults often urinate at night. The natural aging process affects the speed to which their eyes can adjust to changes in lighting, and sometimes they cannot get to the light switch across the room without having to ambulate. The inability to see creates a fall risk. Several solutions exist to address this issue. Motion sensor night lights are useful to illuminate the pathway to the bathroom. Some have the capability to turn off once the person has passed the light. Another solution is to place adhesive motion-sensor rope lights under the side edge of bed frames. When a person places his or her feet on the floor, the lights will activate, but because they are under the bed frame edge, the brightness will not be overwhelming. This will help illuminate the floor and assist with location of any mobility device. In terms of lighting, blue or green light should be avoided; it disrupts people’s circadian rhythms. Toggle light switches are the usual choice in most homes and buildings. However, someone with arthritis, hand contractures, or decreased hand strength can have trouble with the precision and strength required to pinch the toggle and move the switch. Rocker switches require less physical effort and precision to
manipulate. They can also be activated with a shoulder or elbow if required. All homes designed for older adults should use rocker switches versus toggle switches (see Figure 5). While the white switch plate in Figure 5 on a white wall does not have good contrast, the use of the rocker switches will support the ability to turn lights on and off. Closets present a unique challenge. The door handles can be difficult to manipulate if they are round knobs. Replacing all door handles throughout the house with lever handles reduces strain on hands and allows doors to be opened with elbows or additional assistive devices. Lighting can be an issue if the closet has no light or if the light is activated with a pull cord. The addition of motion sensor adhesive puck lights can illuminate the closet well. These lights are LED and run on batteries; LED lights do not need to be replaced for several years. Other puck lights are touch activated and can also be used; they are typically cheaper than motion sensor lights. Finally, the location of the rods in the closet can be difficult for people if they begin to use a wheelchair or develop shoulder problems. Lowering rods and designing a closet with rods at various heights help mitigate this issue and prevent future difficulties. The closet in Figure 6, designed for an aging adult with a recent diagnosis of rheumatoid arthritis, has multiple levels of rods and shelves, which ensures easy clothing retrieval.
Figure 5: Rocker Switches
Figure 6: Closets
Note. From Western Schools, © 2018.
Bathroom The bathroom can be a challenging environment for an older adult. The bathroom is a common place for falls and injuries to occur, and difficulties with toileting and bathing are a frequent reason for older adults to move into facilities (Arcelus et al., 2009). Typical problem areas include tub and toilet transfers, glare from tiles and counters, manipulating faucets, safety in a 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; however, unless there is a powerful pump for drainage, the older adult will be stuck in rapidly cooling water waiting for it to
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