Do it yourself: home-made aids for disabled elderly people

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  • DISABILITY AND REHABILITATION, 1997; VOL. 19, NO. 1, 35-37

    REHABILITATION ENGINEERING

    Do it yourself: home-made aids for disabled elderly people

    A. R. BROWN and G. P. MULLEY

    Accepted for publication: September 1996

    Keywords aids, appliances, elderly, safety.

    Summary

    We contacted the caregivers of patients admitted on a hospital respite care scheme and asked them about home-made or modified aids and appliances. Seven home-made devices were discovered and inspected. They were an electric hoist, a builders plastic skip used as a bath, a wheelchair support and tray made out of chipboard, stair rails made from old steel pipe, an improvised commode and a modified standard commode enabling the user to be cleaned in the sitting position. Several gadgets were innovative; others were dangerous. Two caregivers had injured f hemselves using the improvised aids. Others were at risk of injury. With an increasing tendency for Community Agencies to charge for equipment, more caregivers may design and build their own aids - some of which may be hazardous. Health professionals who visit elderly people at home should look for home-made gadgets with a view to promoting safety and discovering innovations which may help others.

    Introduction

    While listening to the experiences of informal care- givers of elderly people we became aware that some of them had improvised aids and appliances. Some gadgets were born out of frustration at delays in, or lack of provision of, community supplies, others out of ig- norance of what items were available. We undertook to carry out preliminary research in this area.

    Methods

    We contacted the caregivers of dependent elderly people who were intermittently admitted to hospital on a respite care scheme. All the caregivers of respite patients from this unit, those of a consultant geriatrician from another teaching hospital and one geriatrician from a

    Authors: A. R. Brown and G. P. Mulley (author for corre- spondence), Department of Medicine for the Elderly, St Jamess University Hospital, Beckett Street, Leeds LS9 7TF, UK.

    district general hospital were asked about home-made or modified aids and appliances.

    Results

    Forty-six caregivers were identified, 18 from this hospital, and 28 from the other units. Three caregivers could not be contacted, one refused to be interviewed and one was excluded because all care was provided by paid professionals. The remaining 4 1 were interviewed by one of us (A. R. B.) who saw 33 at home and eight on the wards. Six caregivers had made their own, or had modified existing, aids and appliances. Seven devices were identified and inspected.

    Case 1

    A 78-year-old retired builder had problems getting his 79-year-old hemiplegic wife into and out of bed. His own mobility was poor. After seeing a hoist on television he attempted to acquire one, but was told that his wifes disability did not warrant the use of a hoist and as he was unaware that they could be bought privately, he designed and built his own (Figure 1). The hoist was constructed of mild steel with welded joints and was bolted to the wall. An electric motor lifted a cradle and harness, which were slung from a boom. The cradle was placed under his wifes axillae and the motor was operated to lift and swing her into the desired position before being lowered. The operation was done swiftly to avoid her slipping through the cradle. Power was provided by car batteries with a charging unit housed under the bed. A timer was added because continual charging caused overheating of the batteries and the production of acid fumes in the bedroom.

    Case 2

    An 81-year-old man cared for his 80-year-old wife with multiple sclerosis. She could not stand. He improvised a lifting belt, made out of webbing material and a towel. When helping his wife to stand, he stood astride her with

    0963-8288/97 $12.00 0 1997 Taylor & Francis Ltd

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  • A . R. Brown und G. P . Mulky

    Figure 1 Electric hoist

    his back bent. His wife held onto the towel placed around his neck. He put the webbing belt around her waist and, while pulling, straightened his back, thereby lifting her into a standing position. He injured his neck and back as a result of using this technique.

    Case 3

    An 85-year-old man had problems helping his hemi- plegic 82-year-old wife onto the commode: he was

    Figure 2 the bowl to be removed backwards.

    Modified commode. Retaining ring has been cut. allowing

    unable to stand her and clean her a t the same time. Cleaning her while she was sitting on the commode was impossible as the bowl was in the way - it could only be lifted upwards. By cutting and bending the retaining ring which held the bowl in place, he was able to extract it by pulling it backwards (Figure 2). This successfully solved the problem.

    Case 4

    A 71-year-old man with hemiplegia and his 67-year-old wife were not known to community services. He needed a downstairs commode. Unaware that one could be provided, they improvised by removing the seat from a dining chair and placing a bucket underneath. After years of service it was eventually replaced with a more conventional model.

    Case 5

    An 84-year-old man could not get upstairs to the bathroom. His son bought a plastic skip used for mixing mortar and plaster from a builders merchant, which they used as a bath. I t is filIed with buckets of water. His daughter injured her back helping him to get out of the makeshift bath.

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  • Home-made aids for disabled elderly people

    Case 6

    An 82-year-old man's 84-year-old wife fell on the stairs after waiting a year for a stair rail to be fitted. He complained, and soon after a wooden rail was fitted. This, however, was too short. Frustrated by its in- adequacy, and annoyed by the long delay for such a simple device, he extended it with old steel pipe, the cut ends of which were protected with lemonade bottle tops. His wife was then able to get upstairs with minimal assistance.

    Case 7

    The wife of the man in Case 3 tended to slip forward in her wheelchair. He fashioned some chipboard around her waist, supported it on the arms of the chair and secured it with string. When in place the sawn edge of the board cut into her waist, so a cushion was provided for padding. The board was also used as a tray.

    Discussion

    Physically disabled clderly people have particular difficulties with bathing, toileting and mobility.' All but one piece of equipment which we examined helped with one of these functions. Appropriate aids of appliances can be of great help to disabled people, and may improve their quality of life."4 Sometimes suitable aids are not provided, delivered after delays or ~nder-used.~-' Care- givers often rely upon professionals for advice on caring,* but health professionals may not be familiar with the aids and appliances which are available. Some caregivers therefore buy aids, which are often unsuitable; others make do without enabling equipment.

    The patients in this survey are very dependent and are not representative of the elderly population as a whole. All but one of the patients were known to the Community Services at the time that the caregiver made their own gadgets. Many disabled people are not known to the statutory services, and have not been assessed or advised about rehabilitation equipment. We suspect that many more home-made devices exist and are used in the homes of other disabled older people. We intend to study the prevalence of these aids in a community study.

    The safety of home-made devices is of concern. It is government policy to reduce the number of accidents in the elderly.' A prerequisite for a safe home environment is that the equipment within it should be safe. Two caregivers had injured themselves while using their home- made aids. One suffered a back injury as she helped her father out of an improvised bath, which was too low to the floor. The other suffered back and neck injuries while

    moving his wife with the aid of an improvised lifting belt. The power unit for the home-made hoist had overheated and spilled acid fumes into a bedroom, necessitating modifications to the device. The design and type of harness or sling fitted to a hoist is as important as the hoist itself:*.'O the harness made by the caregiver we saw provided inadequate support.

    However, caregivers may have innovative ideas which could be used to the benefit of others. A 12-year-old boy was credited with the design of the first walking frame which he produced for a disabled relative." The modification to the commode in Case 3 could be incorporated into future commode designs.

    The provision and assessment of aids to daily living still leaves a lot to be desired. With an increasing tendency for Community Agencies to charge for equip- ment, more caregivers may decide to design and build their own aids, some of which may be hazardous. For the disabled elderly person the correct and prompt provision of a suitable aid can make the difference between life at home or in an institution. Effective items of equipment such as stair rails12 are cheap, simple and can be easily and quickly installed by those caregivers with basic do- it-yourself skills, if they are told what is required. This would avoid protracted delays and could prevent injury. Health professionals who visit elderly people at home should look for home-made gadgets with a view to promoting safety and discovering innovations which may help others.

    References

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    Mulley GP. The use of aids. In Seymour SA & Summerfield JA (eds) Hori:ons in rehabilitation medicine, No. 3. London: Royal College of Physicians 1991, 119-127. Cochrane M. Aids in the home. British Journal qf'Hospita1 Medicine

    Howell TH. How my teaching about the management of stroke would change after my own. British Medical Journal 1984; 289: 35-37. Mulley GP. Rehabilitation technology: equipment for the disabled elderly. Facts and Research in Gerontology 1994; 8: 58-67. George J, Binns VE. Clayden AD, Mulley GP. Aids and adaptations for the elderly at home: underprovided underused and undermaintained. British Medical Journul 1988; 296: 1365-1 366. Chamberlain MA. Aids and appliances in the home - a critical survey of bath aids and their use. International Journal oJ Rehabilitation Medicine 1979; 1 : 204-207. Hart A, Bowling A. Locomotor disability in very elderly people: value of a programme for screening and provision of aids for daily living. British Medical Journal 1990: 301 : 2 16220. Carers National Association: Listen to Carers, London; 1992. Health of the Nation : A strategy for health in England. London : HMSO; July 1992. Waters K. Everyday aids and appliances: hoists. British Medictrl Journal 1988; 296: 1 1 14-1 117. Stowe J. Stairlifts. British Medical Journul 1990; 301 : 865-869. Dobrin L. Origin and evolution of the Walkerette. Mount Sinui Journal of Medicine I980 ; 47 : 172- I 74.

    1983; 29: 121-126.

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