By Peg Graham, Founder, PPAL
We talk about falls:.why they happen and how to prevent them.
But there’s one root cause of falls that most of us still avoid — toileting transfers.
That’s a problem for the people who need help to transfer on/off a toilet or commode.
PLEASE NOTE: Research reported in this publication is funded by the National Institute Of Nursing Research of the National Institutes of Health under Award Number R44NR019516. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The Cost of Not Talking About Toileting Transfer: Risky Patterns
How do toileting transfers happen right now? ARE they at the heart of persistent falls? No one really knows, there is so little data on this topic. For example, how many times have paid caregivers or family members found that the person who needs help to get to a toilet or commode decided to “just go it alone?”
What happened next?
The caregiver rushing in to help? Too late to stop a fall that could have been prevented?
Or a back injury from a manual lift that shouldn’t have happened?
We call them accidents. But they’re not accidents — they’re patterns.
Patterns we can change.
TWO NEW TERMS:
To make conversations about toilet transfer easier, we use two terms:
“Toileter” refers to people with unreliable, or non-existent, weightbearing that makes walking, or sit-to-stand, difficult. Toileters may lean on others, use a cane, crutches, walker, rollator, or manual/power wheelchairs. The forward thrust of a “sit-to-stand” device is too destabilizing. They lack the strength to pull themselves across using a grab bar. So they depend on others to either help them walk/get up, or deploy a mechanical/powered floor lift or ceiling lift.
“Aide” refers to all the different kinds of people who assist Toileters, using equipment or manually lifting to move on/off toilet or commode. They may be paid staff in a facility or working for a homecare agency. Aides can also be an unpaid family member or friend. Aides may themselves be struggling with back/shoulder strain.
Bathroom is the Goal – And the Hazard
Let’s start with the obvious: Toileters prefer bathrooms as the place “to go.” Bathrooms provide privacy and dignity, containing the uncomfortable – and uncontrollable – sounds and smells that accompany toileting.
Yet, bathrooms are commonly considered the *most dangerous room* in a home (King et al, 2019). Many bathrooms are too small for maneuvers, many toileters are unsteady or unpredictable in their movements (King 2017). People fall on the way to the bathroom (Quigley, 2021), overestimating their own ability to get there safely. Also, staff commonly resort to manual lifting because it is just faster and easier than deploying lifts.
So What are the Choices?
This site will be a forum for sharing information and gathering insights and opinions about toileting transfers. We believe this topic is underappreciated, creating a pain point for older adults that has been overlooked. We want to shed light on the problem, and discuss the need for new solutions. We hope you will join us.
Please note: This research is funded by the National Institute Of Nursing Research of the National Institutes of Health under Award Number R44NR019516. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”