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ADVANCE Outlook: OT

Overcoming Toileting Fear in the Elderly

Published June 22, 2016 1:26 PM by Jon Bassett

Editor's Note: This blog was guest-authored by Mayte Lucia Gomez Sosa, MSOT, OTR/L, COTA/L, CLT

Dehydration among our geriatric patients is a real and growing problem, and quite common in skilled nursing and acute rehabilitation centers. Many seniors are on diuretics medication, diet and fluids are often restricted by physician orders, and many older residents limit their fluid intake to avoid burdensome trips to the bathroom.

Fear of falling, clothing management, transfers, and the time-consuming efforts of pericare and handwashing cause many elderly people to dread the frustration of toileting. Lack of endurance, ROM, and strength are limiting factors. Many residents must be accompanied to the bathroom and require some level of supervision.

As occupational therapists, self-care retraining is part of our scope of practice and a primary goal during acute rehabilitation. Toileting is a major component of retraining, and a lack of compliance and care follow-through can create dependency among the elderly, along with the potential skin care issues that can develop when patients don't ask for help or use alternative means of voiding.

Implementing therapeutic exercises along with self-care retraining is vital for maximum independence. Toileting schedules and flow charts can help minimize voiding accidents and facilitate self-care retraining, bladder control, compliance and a reduced of fear of falling. Fluid intake should be encouraged unless medically contraindicated, and patient education on the effects of poor fluid intake should be provided daily.

Our older patients who rely on us deserve no less.

Mayte Lucia Gomez Sosa is an occupational therapist in Florida.

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