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J Appl Gerontol. 2017 Apr 1:733464817702477. doi: 10.1177/0733464817702477. [Epub ahead of print]

Assisting Frail Seniors With Toileting in a Home Bathroom: Approaches Used by Home Care Providers.

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1 Toronto Rehabilitation Institute-University Health Network, University of Toronto, Ontario, Canada.
2 Conestoga College Institute of Technology & Advanced Learning, Kitchener, Ontario, Canada.
3 University of Waterloo, Ontario, Canada.


Home care providers experience high occupational injury rates. Improving safety is becoming increasingly urgent as this sector expands to support the aging population. Caregivers identify assisting with toileting as a particularly frequent and difficult activity. This mixed-methods observational study identified and analyzed the toileting subactivities that place care providers at the greatest risk of musculoskeletal injury. Eight personal support workers (home care aides) assisted a frail older adult (actor) in a simulated home bathroom. Overall technique and body postures were analyzed. Exposure to musculoskeletal injury risk factors (low back loads and time in extreme trunk postures) was greatest when removing/replacing clothing and providing posterior perineal care; high loads were also possible during transfers. Exposures can be reduced by lowering the pants only to knee level or squatting to raise them. A bidet seat or attachment can perform perineal cleaning, which accounted for 32% of time in severe trunk flexion.


back injury; ergonomics; home health care workers; musculoskeletal disorder; toileting


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