Getting in and out of the bathtub or shower may be a dangerous task for many older adults. A study suggests a third of adults over age 60 have difficulty climbing in and out of the bathtub or shower, and more than 70 percent of those with shower stalls use unsafe features such as the glass door or towel bar for support.

“For older adults, losing the ability to bathe is associated with having falls, fracturing bones, and even being admitted to a nursing home. It is important that we take steps to help to prevent bathing disability before it occurs,” says researcher Susan L. Murphy, ScD, OTR, an occupational therapist at the University of Michigan Medical School’s division of geriatric medicine.

In the study, published in the Journal of the American Geriatrics Society, researchers videotaped 89 independently bathing adults over 60 as they demonstrated (fully clothed) how they normally get in and out of the shower or tub. The average age was 82 years, and most of the study participants were women.

Researchers examined their movement and noted if the participants had difficulty negotiating the environment or used things like grab bars, towel bars, shower curtains, glass doors, tub seats, or other parts of the tub to assist themselves.

The results showed that a third of the older adults had difficulty getting in or out of the bath. The most common problem was falling or difficulty positioning themselves onto a tub seat or into the bathtub.

About 30 percent of the participants hit the sides of the tub or the bath seat with their legs during the transfer.

Nineteen percent of the participants using a tub used unsafe features, and 70 percent of those with shower stalls used unsafe features.

The biggest problem was using sliding glass doors in shower stalls for stability or balance. More than three-fourths of older adults who had shower stalls used the sliding glass door for assistance.

“This is extremely unsafe because shower doors were not designed to support a person’s weight,” says Murphy. “This problem could be easily remedied by educating older adults not to use the door as a support or possibly replacing it with a shower curtain, which was used only rarely by older adults in this study.”

The second most commonly used unsafe feature was the towel bar, which was used by about half of the participants.

“While bathrooms in senior housing facilities are designed to be safe, we have found that older adults often do not know the difference between a grab bar and a towel bar. They also have unsafe strategies of getting into and out of their shower or tub,” says Murphy. “We think the results from this study demonstrate the need for health care professionals to become involved in helping to prevent bathing disability, instead of just treating people in the hospital after they have had a fall in the bathroom.”

In 2004, the most recent year statistics are available, almost 15,000 people 65 and older died from falls and about 1.9 million were treated for injuries in emergency rooms, said Judy Stevens, an epidemiologist with the Centers for Disease Control and Prevention.

“I think the magnitude of the problem is something that people don’t recognize,” Stevens said. “It really is a serious issue for older adults.”

Making sure that people over the age of 65 know how to avoid falling or being injured by a fall is the goal of a campaign launched this month by the National Athletic Trainers’ Association and American Academy of Orthopaedic Surgeons.

The organizations say in addition to exercise, older people can make their homes safer by installing night lights, bathroom grab bars and slip- resistant floors.

“If we continue to exercise, especially strength training, we decrease the loss of bone density. Just by working on strength training, you’re working your muscles to keep strong,” said Joe Scott, a NATA member who is outpatient orthopedic team leader for Southcoast Hospitals Group in New Bedford, Mass.
Scott said that as people get older, they’re less active so they lose strength. Also, sight and balance problems can creep in.

Stevens also said it’s a good idea for older people to have a doctor review their medicines each year to look for things like drug interactions that could lead to dizziness.

Experts say certain exercises — yoga, tai chi, and trying to balance on one leg with your eyes closed — can help improve balance.

If a younger person slips, they’ll usually catch themselves, but older people often have less strength and slower reaction times, experts say.

Injuries from falls in the elderly can include broken wrists, elbows, arms and hips, said Dr. Jay Mabrey, chief of orthopedics at Baylor University Medical Center in Dallas.

Tai chi, an ancient Chinese martial art, may improve senior citizens’ strength and help them avoid falls, South Korean researchers find. Regular exercise is very important as we get older because when we get to 65 we start losing muscle strength at a rate of up to two percent per year. It is effective in fall prevention for older people because of improvements in strength and balance.

The researchers tested tai chi in older adults. The slow, gentle, and continuous movements help them develop stronger muscles, better balance control, concentration, and psychological well-being.

They found benefits including:

•  Stronger knees and ankles
• Better balance and flexibility
• Improved walking
• More confidence in the ability to avoid falls

The tai chi students had fewer falls than others who didn’t take the class. Their study appears in the Journal of Advanced Nursing.

Tai chi uses slow, fluid body movements. It’s not a jarring form of exercise. Health experts want everyone to get enough exercise. That includes older adults.

Every year, about 30% of people aged 65 and older and living on their own fall. Some of the risk factors that lead to falls in seniors include imbalance, muscle weakness, and lack of flexibility — all of which can be modified.

Seniors who fall and are seriously injured may take a long time to recover. Meanwhile, they may be sidelined from their normal routine. That can lead to physical decline and depression.

The tai chi students had stronger knees and ankles than their peers. They also improved in flexibility and walking. The tai chi group had fewer falls during the study.

This is not to say that taking Tai Chi will definitely help you prevent falls but it may and it’s good for your body.

Getting in and out of the bathtub or shower may be a dangerous task for many older adults. A study suggests a third of adults over age 60 have difficulty climbing in and out of the bathtub or shower, and more than 70 percent of those with shower stalls use unsafe features such as the glass door or towel bar for support.

“For older adults, losing the ability to bathe is associated with having falls, fracturing bones, and even being admitted to a nursing home. It is important that we take steps to help to prevent bathing disability before it occurs,” says researcher Susan L. Murphy, ScD, OTR, an occupational therapist at the University of Michigan Medical School’s division of geriatric medicine.

In the study, published in the Journal of the American Geriatrics Society, researchers videotaped 89 independently bathing adults over 60 as they demonstrated (fully clothed) how they normally get in and out of the shower or tub. The average age was 82 years, and most of the study participants were women.

Researchers examined their movement and noted if the participants had difficulty negotiating the environment or used things like grab bars, towel bars, shower curtains, glass doors, tub seats, or other parts of the tub to assist themselves.

The results showed that a third of the older adults had difficulty getting in or out of the bath. The most common problem was falling or difficulty positioning themselves onto a tub seat or into the bathtub.

About 30 percent of the participants hit the sides of the tub or the bath seat with their legs during the transfer.

Nineteen percent of the participants using a tub used unsafe features, and 70 percent of those with shower stalls used unsafe features.

The biggest problem was using sliding glass doors in shower stalls for stability or balance. More than three-fourths of older adults who had shower stalls used the sliding glass door for assistance.

“This is extremely unsafe because shower doors were not designed to support a person’s weight,” says Murphy. “This problem could be easily remedied by educating older adults not to use the door as a support or possibly replacing it with a shower curtain, which was used only rarely by older adults in this study.”

The second most commonly used unsafe feature was the towel bar, which was used by about half of the participants.

“While bathrooms in senior housing facilities are designed to be safe, we have found that older adults often do not know the difference between a grab bar and a towel bar. They also have unsafe strategies of getting into and out of their shower or tub,” says Murphy. “We think the results from this study demonstrate the need for health care professionals to become involved in helping to prevent bathing disability, instead of just treating people in the hospital after they have had a fall in the bathroom.”

Fecal incontinence is a difficult condition to face. However, awareness has increased tremendously over the past 10 years. Treatment continues to expand and provide patients and their healthcare provider options specific to their needs. Talk to your doctor about treatment options that are right for you.

Sometimes even small lifestyle changes such as dietary modification or eliminating certain medications (a side effect of certain medications is diarrhea) can be helpful in regaining bowel control. Taking medications or increasing fiber to change the consistency of the stool may provide relief, since a person can usually better control stool when it is firm rather than loose or liquid. The first steps to controlling incontinence are to normalize stool consistency with increased fiber intake, to bulk up stool, and to exercise the pelvic floor. Often, treatment includes both medical and behavioral therapy.

•  Lifestyle Modifications — If your fecal incontinence is associated with constipation, then good fluid intake, regular exercise, and regular bowel habits can be helpful. Having a good breakfast with tea or coffee and then routinely going to the bathroom may help get and keep you regular. Alternatively, for some people avoiding caffeine may be helpful.
• Medications — Your provider will review your prescribed and over-the-counter medication to determine if any may cause constipation. If you are constipated, then regular laxative and stool softeners as recommended by your provider will be important. If you have diarrhea, supplements to firm stool can increase bowel control since firmer stool is usually easier to control than liquid stool. None should be taken, however, without recommendation of a healthcare provider.
• Exercise — Pelvic floor muscle exercises and Kegel exercises, when performed regularly and correctly can greatly improve the anal sphincter muscle tone. This often leads to increased bowel control and a reduction or elimination of fecal incontinence episodes within a few weeks. To perform the exercise, contract the muscles of the anus as tightly as possible (as if you are trying to prevent the passage of gas) for a count of five and then relax. Repeat 30 times, three times daily.
• Biofeedback –Biofeedback is a non-invasive technique that converts anal sphincter muscle contractions to a visual meter on a computer screen to help a patient become more aware of their anal sphincter muscles. This technique can be used to teach or supplement exercises.

People who continue to experience fecal incontinence despite other treatments may require surgery to regain control. Surgical options depend on the cause of the incontinence, the severity of the problem, the health and age of the patient, and the clinical judgment of the surgeon.

Management Options

• Fecal Incontinence Collection Systems — With multiple options ranging from bags adhered directly to the skin to catheters and tubes attached to a collection bag, there are many management options for fecal incontinence.
• Absorbent Products — A variety of disposable or reusable absorbent products that may be used during treatment exist.
• Skin Products — Fecal material can cause many problems including skin irritation and breakdown, which increase the risk of infection and are often painful for the patient. Many products exist to help maintain skin integrity including special cleansers that maintain skin pH while cleansing, moisturizers, and moisture barriers that help protect the skin from irritants or moisture. Many also include fragrances and anti-bacterial components both of which should be used with caution. Fragrance can often increase irritation, exacerbating the problem, and routine anti-bacterial use remains controversial as little evidence exists about its effectiveness.

Incontinence (in-CONT-ti-nunce) is the loss of bladder or bowel control. A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirth. In itself, incontinence is not a disease - it is a symptom.

There are several basic types of urinary incontinence:

1.   Urge incontinence, or overactive bladder, is the urgent need to urinate, often with the inability to get to a toilet in time. It occurs when nerve passages along the pathway from the bladder to the brain are damaged. Sudden bladder contractions occur that cannot be consciously controlled.
2. Stress incontinence occurs when pelvic muscles have been damaged, and the bladder leaks during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder.
3. Mixed incontinence occurs when symptoms of both stress and urge types of incontinence are present, and is very common.
4. Overflow incontinence is the leakage that occurs when the body produces more urine than the bladder can hold.
5. Fecal incontinence is the inability to control the passage or loss of gas, liquid and/or solid stool. This condition can vary from being partial, in which a person loses only a small amount of liquid waste, to complete, in which the entire solid bowel movement cannot be controlled. Incontinence from surgery is a temporary condition that follows operations such as hysterectomies, caesarean sections, prostatectomies, lower intestinal surgery, or rectal surgery. Incontinence can also occur due to other reversible factors, often outside of the urinary tract, such as restricted mobility.
6. People who suffer from incontinence may feel their healthcare provider does not understand what they are going through, but it is very important to speak with your doctor if you’re having a problem with incontinence.

The National Associate for Continence (NAFC) has prepared this Bladder and Bowel Control Diagnostic Tool to help you determine and understand the type of incontinence your symptoms indicate. This web tool is not meant to substitute a diagnosis from a qualified healthcare provider and is not provided by Disposable Medical Express.

Each year, 35-40% of older adults fall at least once. The best preventative measure is to take steps to improve bathroom safety to help avoid a fall, but you should also plan for a fall in the event that it occurs. Falling down is not just the result of getting older; it can be caused by a variety of circumstances.
Knowing how to help reduce injury, and to have a plan in place in advance when a fall occurs will help the older adult cope.

•  Improve Your Body Balance with Exercise - lack of exercise leads to weakness in the body
• Increase Your Home’s Accessibility and Safety - install grab bars and shower and toilet safety products
• Watch Out for Medication Side Effects - many medicines can cause diziness or fatigue
• Have Vision Checked Regularly - have regular eye exams to keep eyeglass perscriptions current

The bathroom can often be the most dangerous room in your home. Use our checklist to make sure you’ve done all you can to provide a safe bathroom for yourself and the older adults you love.

• Have you installed high quality grab bars in the bath tub and shower?
• Are you careful not to use towel racks or wall-mounted soapdishes as grab bars?
• Do you use a non-slip mat or have adhesive safety strips installed in bathtubs and showers?
• Do you promptly wipe up excess water from the bathroom floor?
• Do you have a non-skid bath mat for every bathroom?
• Do you use cleaning supplies that don’t leave a slippery residue behind?
• Do you use nightlights to help light hallways and bathrooms during the night?
• Are medications, including vitamins, prescription drugs and over-the-counter drugs clearly labeled and properly stored?
• Are all bathrooms in your home protected by ground fault circuit interrupters (GFCIs) and tested monthly to ensure they operate properly?
• Are small electrical appliances such as hair dryers, curling irons, and razors always kept away from water and unplugged when not in use?

Ensuring bathroom access and safety is necessary for older adults. Most accidents occur at home, so family members with older relatives need to access their loved ones’ bathroom. Some home bathrooms are easy to equip for safety and others need more extensive room renovations for those who wish to stay at home and remain independent.

Bathtub Safety
Falls often occur when getting in or out of the tub. Non-slip suction mats or rubber silicone appliqués in the tub will help prevent falls. A non-skid, latex-coated bath mat on the floor beside the tub also provides firm footing. Consider one of the new walk-in bath tubs available on the market today. Although expensive, they provide additional safety since the bather doesn’t need to climb in or out.

Safety Bars
Grab bars around the bathtub and toilets are a safety necessity. These bars should be institutional-grade, stainless steel and installed according to the manufacturer’s directions for firm, solid support. Don’t rely on the cheaper model you’ll find in bed and bath stores - they are more decorate and don’t provide the solid support needed. These bars are expensive, but, when properly installed, will support a person who loses balance. You’ll find a wide selection of grab bars  in multiple finishes and styles at Disposable Medical Express.

Two types of grab bars may be needed at the tub for the ambulant older person:

1. For use in getting in and out of the tub from a standing position;
2. For use when lowering or raising the body to or from a seated position in the tub.

U-shaped bars are generally available in 12- to 40-inch lengths and may be secured vertically or horizontally to a wall. A vertically placed U-bar, attached to the side wall at the foot of the tub, allows safe entry and exit. Horizontally placed support bars are best for lowering or raising the body to the seated position in the tub. A 12- to 15-inch grab bar can be placed at the foot of the tub and add another longer one along the back wall for added safety.

Tub Seats
A variety of portable seats, chairs and benches and transfer benches are available if sitting on the bathtub floor is difficult or impossible. The seat can be used to swing into the tub and remain elevated during bathing so you don’t have to get on the bathtub’s floor. When using these seats in the tub, a hand-held showerhead is also needed.

Shower Bars
An angle bar attached to two walls of a shower provides support while standing in the shower, or as an aid to sitting and rising if using a bath bench or chair. Use a non-slip suction mat on the shower floor and a non-skid bath mat outside of the shower to avoid slipping.

Water Temperature and Controls
A single-lever mixing faucet can control temperature and flow of water better than dual controls. All hot water in an older person’s home should be controlled thermostatically to a maximum temperature of 120 degrees to avoid burns. you can find thermostatic control shower controllers online, thru specialty plumbing stores, or you can often special order these items from home improvement stores.

Toilet Safety
The standard 15- to 17-inch height of toilet seats creates a problem for many people, especially those with arthritis, hip, knee or back problems. Elevate the seat 5- to 7- inches for better leverage when standing. There are several types of removable and permanently fixed raised toilet seats available at Disposable Medical Express.