Can technology-assisted toilets improve hygiene and independence in geriatric rehabilitation? A cohort study

Abstract

Purpose: To investigate whether technology-assisted toilets (TATs) could be used to improve toileting hygiene and independence for geriatric rehabilitation patients. TATs are commercially available toilet seats that use a stream of warm water to clean the user, have a fan for drying and are operated by a remote control.

Materials and methods: Twenty-five geriatric rehabilitation in-patients were recruited, six completed the study, and seven partially completed the study. Each participant had two trial bowel movements. One trial involved cleaning themselves with toilet paper; the other involved cleaning themselves with the TAT functions. After each trial, participants received a visual inspection for cleanliness and answered the Psychosocial Impact of Assistive Devices Scale (PIADS), a validated scale, to assess their sense of competence, adaptability and self-esteem in the bathroom. A toileting cleanliness scale, designed for this study, was completed by a nurse after TAT usage. Participants received a score from 1 (completely clean) to 4 (completely soiled) based on a visual inspection after cleaning.

Results: TAT and toileting cleanliness scores were similar. PIADS scores showed a trend towards higher scores when using the TAT, but results were not statistically significant.

Conclusions: TATs cleaned as well as standard toileting in geriatric rehabilitation inpatients. Participants indicated that TATs improved their sense of competence, adaptability and self-esteem. Geriatricians and rehabilitation professionals should consider prescribing TATs in their practice as an assistive device in order to promote patient independence and dignity and reduce the burden of care for patients requiring toileting assistance.

Implications for rehabilitation

• Technology-assisted toilets (TATs) are commercially-available toilet seats that could be used to allow rehabilitation patients to clean themselves more independently in the bathroom.

• Improved toileting independence can reduce burden of care of geriatric rehabilitation and reduce the impact of toileting assistance on patient dignity and self-esteem.

• Physiatrists should consider recommending TATs to their patients but should take into account whether a patient’s particular set of disabilities will allow them to use a TAT effectively.

Keywords:

• Toileting
• assistive technology
• rehabilitation
• hygiene
• independence

Acknowledgements

The authors would like to thank Vanessa Fuso and Myrna Robinson, who ensured our participants’ safety and assisted our participants during data collection. We would also like to thank all of the staff at the Elisabeth Bruyère Hospital Geriatric Rehabilitation Unit for allowing us to use their facilities and for assisting us in identifying patients for recruitment.

Disclosure statement

David Yachnin received funding and in-kind contributions from TOTO USA in order to conduct this research.

Geolocation information

This study was conducted at the Elisabeth Bruyère Hospital in Ottawa, Ontario, Canada.

Additional information

Funding

Bruyère Academic Medical OrganizationBAMO01–

TOTO USABruyère Academic Medical Organization Incentive FundBAMO01-1415This work was supported by the Bruyère Academic Medical Organization under grant number BAMO01–1415 and by TOTO USA.