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 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 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). Countertop choices tend to be a matter of preference for the older adult. They can be useful as alternative storage places for items in kitchen cabinets or microwaves that are too tall to use. Countertops may need to be lowered to 28” to 34” to accommodate potential wheelchair use; a kitchen might include counters of varying heights for all users. Corners should always be rounded to avoid potential injuries during inadvertent collisions. Changes in vision can make it difficult for people to discern objects and dirt, especially with busy granite countertops. Plain countertops with good contrast between the counter and appliances make it easier to clean and discern between objects in the kitchen. Matte countertops are also ideal for reducing glare. The clinician should also pay attention to
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.
windows, sun directions, and lighting to determine the glare at various points of the day. Figure 7: Cabinets and Drawers
Note. From Western Schools, © 2018. Appliances in the kitchen become difficult to use due to decreased hand function and the introduction of mobility devices. Transporting objects from the refrigerator can be tricky, especially when using a walker. The clinician should assess whether the swing of the refrigerator door blocks islands and counters; if so, some refrigerators have the capacity to switch the sides of the door hinges. Side-by-side-door refrigerators with slide-out bins and shelves are best. Some refrigerators come with large lettering, long door handles, and lighting on the ice maker and water dispenser. Stovetops can be potentially dangerous. Moving controls to the front or top front of the stove reduces the need to reach over hot areas. Some stoves also come with larger knobs, which will be easier to manipulate as someone ages. Microwave placements are also a common problem for older adults who can no longer reach them; clearing space on the countertop or using a microwave cart solves this problem. Sinks can become too deep and the faucet more difficult to manipulate. Replacing the faucet knobs with a lever faucet or a touch or motion sensor system makes controlling the water easier. The sink depth can also be lessened by adding sink bottom grids. An ideal sink for aging in place is about 6.5” deep to eliminate excess bending and reaching. Raising the dishwasher can also help in the same way, though this can create a bump in the countertop. Dishwasher and microwave drawers, while an interesting concept, are not the best ideas for older adults because hot air and steam will rise into their faces when opening the unit. Along the same lines, setting the hot-water gauge to a lower temperature will avoid scalding. The stove in Figure 8 has large, easy-to-turn knobs that
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Book Code: PTNY3622B
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