Date Presented 4/20/2018
Informal caregivers provide critical care for older adults but receive little to no training or support, especially with toileting. Preliminary results suggest that an automated bidet system is acceptable and feasible, can improve caregiver outcomes, and has potential to reduce caregiver burden.
Primary Author and Speaker: Rebecca Bollinger
Contributing Authors: Emily Somerville, Marian Keglovits, Susan Stark
PURPOSE: Informal caregivers provide critical care for older adults but receive little to no training or support. This increases their risk for physical injury, stress, and burden, especially if they are less satisfied, or assist with physically demanding activities of daily living such as toileting. Automated bidet systems, which are toilet seats with built-in cleaning features, have the potential to reduce physical support needed for toileting, improve satisfaction, and reduce the number of older adults who are institutionalized because of the need for assistance with toileting. The purpose of this study was to determine whether an automated bidet system was acceptable and feasible to reduce the amount of physical assistance required from a caregiver for toileting and improve caregiver outcomes.
METHOD: We conducted a randomized wait-list control pilot study (N = 10) with caregivers in St. Louis, Missouri. Informal caregivers were recruited from a participant registry at Washington University in St. Louis and through snowball sampling via flyers distributed to clinicians associated with the university, exercise groups, and word of mouth. Caregivers were included if they lived with a care recipient aged 55 or older, had provided assistance with toileting for ≥6 mo before the start of the study, and did not have an automated bidet system; if installation was feasible (working toilet and GFCI outlet in the bathroom); and if the care recipient was willing to participate.
Caregivers completed assessments before and 30 days after the intervention; assessments included a semistructured interview for acceptability and feasibility at the final visit and measures of performance, satisfaction, self-efficacy, environmental barriers, amount of assistance provided for toileting, and perceived stress. Data were analyzed using descriptive statistics.
RESULTS: Ten caregivers consented to participate; six have completed the study to date (M age = 65.5; 66.7% female; 66.7% spouses). We maintained a 100% retention rate throughout the study. All six caregivers reported that the automated bidet was aesthetically pleasing and made it easier to assist with toileting and that they planned to use it after the study. Intervention caregivers’ scores increased for performance (M = 2.75, 4.25), satisfaction (M = 2.75, 4.50), and self-efficacy (M = 2.75, 4.50) from pre- to postintervention. Control caregivers’ self-reported performance (M = 4.00, 2.50), satisfaction (M = 3.50, 2.50), and self-efficacy (M = 4.00, 3.00) decreased from pre- to postintervention. For the intervention group, barrier severity decreased (M = 10.50, 8.75), self-care increased (M = 2.75, 3.50), transfers decreased (M = 4.25, 4.00), and perceived stress (M = 10.25, 12.00) increased from pre- to postintervention; there were no changes for the control group.
CONCLUSION: Preliminary results from this pilot study suggest that the automated bidet is acceptable and feasible and makes it easier for caregivers to assist with toileting. By contributing to improvements in caregiver outcomes, it has the potential to reduce caregiver burden, thereby improving caregivers’ health and well-being and provision of care for millions of older adults annually, enabling them to age in place. Additional research is needed to establish the effectiveness of this intervention with a larger, more diverse sample.
References
Darragh, A. R., Sommerich, C. M., Lavender, S. A., Tanner, K. J., Vogel, K., & Campo, M. (2015). Musculoskeletal discomfort, physical demand, and caregiving activities in informal caregivers. Journal of Applied Gerontology, 34, 734–760. https://doi.org/10.1177/0733464813496464
DiZazzo-Miller, R., Samuel, P. S., Barnas, J. M., & Welker, K. M. (2014). Addressing everyday challenges: Feasibility of a family caregiver training program for people with dementia. American Journal of Occupational Therapy, 68, 212–220. https://doi.org/10.5014/ajot.2014.009829
Keglovits, M., Somerville, E., & Stark, S. (2015). In-Home Occupational Performance Evaluation for providing assistance (I-HOPE Assist): An assessment for informal caregivers. American Journal of Occupational Therapy, 69, 6905290010. https://doi.org/10.5014/ajot.2015.015248
