The clinical utility of the electronic toilet-top bidet for Australian nursing home residents and staff

Abstract

Inability to self-toilet has negative outcomes for older people, including risk of admission to residential care. In residential care, toileting is the most frequent task undertaken by staff and may provoke distress, particularly for people with dementia. This work comprises an iterative, mixed methods investigation of the feasibility and clinical utility of the wash-and-dry toilet-top bidet for older dependent people, staff and family carers. A literature review and three exploratory studies were conducted. First, interviews with five family carers found the bidet acceptable if it met physical and symbolic needs. Ongoing use was mediated by environmental constraints, cleaning ability, reactions of the older person, and quality of interactions with health professionals. Carers reported it cleaned reliably, reduced incontinence and helped ‘normalise’ familial relationships. Second, a single-arm study in a dementia aged care home (ACH) found bidets were feasible and acceptable for residents and staff, were reliable, and cleaned effectively. Staff workload and facility expenditure on incontinence products decreased. Third, a non-randomised, controlled pilot study in two ACHs (n= 49 residents, 73 staff) found bidets were acceptable, reduced staff workload, improved resident behaviour during toileting and lowered rates of constipation. No changes were found in incontinence associated dermatitis or odour. Residents in the bidet condition were more likely to have a clear case of bacteriurea or a probable urinary tract infection, however higher rates of faecal incontinence at baseline may have mediated this result. The studies have ecological validity and bidet technology shows promise for improving dignity and ease of toileting. These studies have contributed to a more nuanced understanding of factors that influence uptake and ongoing use of assistive technologies in aged care settings, and development of measures also provides a basis for future confirmatory studies.