Humans are designed to stand but most of us cannot remember learning as when unhindered we usually start to develop this skill between 7-12 months old. However, it is something that we often take for granted; until it becomes difficult.
We stand up for so many reasons whether it be for play, work, leisure, function, instructed or comfort and the benefits of standing for those who can are widely documented. It is known to improve bone density, prevent contractures, improve respiration, enhance circulation, improve blood pressure, aid digestion, support bowel and bladder function and maintain or improve skin integrity. As well as the physical benefits, physiologically, standing can improve support social interactions, participation in occupations and overall wellbeing.
So, when it becomes difficult it can have an impact on almost all aspects of our lives and can dramatically affect a person’s wellbeing. Whether it is a sudden or a gradual deterioration, the person may grieve the loss of their independence and their identity as someone who has autonomy over their life and decisions. They may struggle to accept they need to ask for help and their occupational participation will reduce due to the physical difficulties or the emotional distress. This may result in an overall de-conditioning of their physical self, creating further cyclical deterioration.
According to the House of Commons Library Research briefing UK Disability statistics prevalence and life experiences (July 2022) 22% of the population in the UK reported themselves as disabled. This was further broken down into types of impairment with “Mobility” and “Stamina/breathing/fatigue” being the two with the highest prevalence (46% and 33% respectively). Assuming that many of the people with these impairments have some difficulties standing, and that there will be many more who struggle with standing but do not see themselves as disabled or weren’t included in the study, means there are 12milion or more people who find standing transfers problematic in the UK.
The office of national statistics reported that 23% of people with disabilities reported that they feel a burden on others, this is significantly higher with only 7% of people without disabilities feeling this way. Considering the need to stand is integral to so many occupations, supporting with this specific occupation can have a dramatic impact on the whole of someone’s overall wellbeing and the provision of equipment can reduce this reliance on others.
Providing equipment to support with safer standing transfers lowers the risk of falls and helps with energy conservation enabling increased participation in other occupations. For example, some people report that they do not drink much in order to try and reduce the amount of times they need to get up to go to the toilet. This can have substantial damaging effects on their body and so providing a riser chair to enable independent standing transfers may result in someone being able to mobilise to the toilet thus reducing the risks of UTI’s and dehydration. In turn this provides increased energy to be more alert throughout the day to participate in other occupations.
Riser chairs are one of the most used pieces of compensatory equipment as they are widely available for people to buy as well as being provided by the NHS and social care in many areas. However, when considering many falls happen in the bathroom, this is an area where dynamic rising equipment is not as often provided. When completing a task analysis of standing, if a dynamic supported raiser function is required in a chair in the living room, then it is likely that more than just a grab rail is needed in the bathroom. However, it is not as simplistic as saying a raised toilet will reduce falls and the need for carers, transfers are only one part of toileting independently. To enable someone to be fully independent with toileting a more holistic approach is needed. From transferring from their comfort chair, mobilising to the toilet, transferring to the toilet, performing self-care, dressing, and transferring off. Promoting independence with all aspects of toileting helps maintain one’s dignity and can totally negate the need for carer support.
With a focus on toileting, it is almost a futile task to enable someone to transfer independently if they then need carer support to clean after toileting. Provision of a wash dry toilet such as the Closomat Palma Vita supports with the most personal part of toileting; meaning a carer is not needed for cleaning but can also be fitted at different heights to support with transfers. Future proofing with accessories that can be included at installation or added on at a later time, for example arms rests, are essential to ensure the toilet meets long term needs without additional major works being completed.
There are times when simply a higher toilet is not enough to promote independent transfers. If someone has a hip condition that affects flexion of the joint, a toilet that is high enough to support with standing transfers may be too high to enable someone to open their bowels comfortably but a toilet that is too low may not support them to stand easily. Grab rails and arm rests may provide some support to make this easier but may not support someone for the medium to long-term if their condition deteriorates. In this case further equipment and support is needed to enable someone to continue to remain independent with transfers. Equipment such as the Aerolet toilet lift can be added in addition to the Palma Vita, or a standard domestic toilet, and can be customised with either a vertical lift or tilting action to assist someone to stand. It is suitable for a range of users with a variety of support needs depending on the outcome of the assessment and task analysis.
When someone’s ability to stand deteriorates it affects not only themselves but those around them. The family may struggle to support an individual to stand and outside carers may be needed. However, this is not always the case. With early intervention of the correct equipment to enable someone to stand independently when completing a variety of tasks, we can help maintain that persons independence and dignity and in turn reduce the 23% of people who feel like a burden on others.