Geoff Fernie, PhD, PEng, CCE
Centre for Studies in Health and
Aging, Sunnybrook Hospital and Women's College Hospital, North York, Ontario
Does anyone know why toilets are so low in North America? Many elderly people find it really difficult to stand up from them. They are also too low for an easy lateral transfer from a wheelchair. What are the solutions to this common problem?
The problem is twofold:
- How can the toilet seat be raised?
- How can a grab bar be provided as an effective aid to rising?
The typical height of a toilet bowl without the seat is 14.5" whereas the optimal height of the seat is about 19". This corresponds to the height of a typical wheelchair seat and to the Canadian Barrier-Free Design code.
There are three solutions to the seat height problem:
- The most common solution is to purchase an add-on raised toilet seat. About 500,000 people do this in North America every year. These are hollow plastic units that fit on top of the toilet. Usually they replace the existing toilet seat. They come in various thicknesses. Four to Five inches is generally about right. The manufacturers claim that they fit most toilets but it is important to check the security of the fit since accidents do occur. Some of them come with clamping mechanisms, some bolt through the toilet seat attachment holes, and others have no attachment system. Some can be filled with sand or water to increase stability.
- An alternative Canadian product, Toilevator®, fits under the toilet to raise it. This product was recently voted as the best new product for the year 2000 by the Canadian Hardware and Housewares Manufacturers Association. It has the advantage of being inconspicuous and does not create instability or cleaning problems. Since the regular toilet seat is still used, Toilevator® only needs to be 3.5" thick. It has the disadvantage of requiring installation by a handy-person or a plumber. Please note that Toilevator® is another of our inventions from The Centre for Studies in Aging; for this reason, I must declare a conflict of interest.
- Buy an extra high toilet. These are available, but this is a more expensive solution and does not allow for reversal to the original height. The reasons for wanting to return to the low height may include progression to the use of a rollover commode or moving from one house to another.
Elimination is made easier by a more flexed hip posture. If this is a consideration then it may be appropriate to have a light foot stool available. Toilevator® can be installed to create deliberately a small step at the front that may be adequate for this purpose.
There are several solutions to providing a grab-bar to help in transferring on and off the toilet.
- The most flexible solution is to use one of the vertical pole devices. These are held in place by compression between the floor and the ceiling and will not work if the bathroom ceiling is made of a grid of suspended removable panels. However, they can be tried in different locations until the optimum position is found
- Grab-bars can be attached to the wall. We will cover the topic of selecting and installing wall grab bars in a later article. The problem is that they are often too far off to the side to provide enough assistance.
- Horizontal rails that are attached to the back wall and can be swung up out of the way are often used in institutions but are rarely used at home because of the difficulty and cost of installation. They have the advantage of providing room for a caregiver to stand to one side of the toilet and give assistance when needed.
- Numerous frame designs are on the market that attach to the toilet or raised toilet seat. Be very careful to select one that is firm enough and big enough to be truly safe and functional. The ones that come as part of a raised seat are often inadequate.
The ability to manage the toilet with safety and dignity is key to independence. These simple adaptations should cost no more than $300 in total and can be done very successfully or very poorly--choose wisely.