Although DME, AE, and AD are used interchangeably, per the national government agency Medicare (Medicare.gov, 2023), DME is characterized by any equipment that can withstand repeated use, is prescribed by a Medicare-enrolled physician for a medical reason for use in the home, that is typically only helpful to someone who is ill or injured, and is expected to last three years. DME includes, but is not limited to, assistive devices (AD). ADs are typically mobility aids, such as canes, crutches, bedside commodes (BSC), walkers, wheelchairs, and scooters (Medicare.gov, 2023; National Institute of Child Health, 2018). AE includes safety equipment like shower chairs, grab bars, and mobility aids that limit task demand and help compensate for intrinsic fall risk factors (like balance impairment) to prevent injury in individuals with limited mobility. AE refers to any equipment that facilitates participation in instrumental activities of daily living, such as rest, sleep, play, leisure, social participation, health management, and work (Bergem, 2020). AE can include mobility devices, referred to as AD and DME.
Rehabilitation professionals training older adults in the safe use of AD, like canes and walkers, can help older adults compensate for intrinsic fall risk factors. However, rehabilitation professionals must exercise clinical reasoning and judgment to select the most appropriate type of AD for the older adult. When doing so, consideration of factors like available strength, endurance, balance, cognition, and the older adult's home environment must be included (Cruz et al., 2020).
BSC, placed on top of regular commodes, can be helpful as AE for assisting older adults with toilet transfers and can help compensate for intrinsic factors like decreased range of motion in lower extremities by raising the height of the regular commode. Please refer to Table 1 for alternative options that raise the height of the toilet. BSCs are also known as 3-in-1 commodes due to their versatility and multi-use features. For example, BSC can also be placed at the bedside to compensate for limited functional ambulation ability in older adults due to strength and endurance impairments, especially during nighttime when limited visibility can further increase the risk for falls. Using BSC as a shower chair can help mitigate intrinsic fall risk factors such as decreased balance, strength, and endurance. Please refer to Table 1 for shower chair options other than BSC.
Fixed grab bars in bathrooms can assist older adults with transfers on and off commodes and in and out of the shower, helping compensate for balance impairments and minimizing fatigue by allowing for weight distribution. The placement and orientation of grab bars have been described under bathroom suggested modifications in Table 1. For adults with somatosensory deficits, grab bars with a textured handle are recommended to compensate for insufficient tactile registration and provide a slip-resistant grip.
Adaptive strategies may address intrinsic factors such as vision impairments outside of DME, AD, and AE. For example, An older adult with contrast sensitivity impairment may be at higher risk for falls in the bathroom because they may be unable to distinguish between the white toilet seat and light-colored flooring. In this case, adapting the environment by replacing the toilet seat with a black one would improve their ability to distinguish between the toilet seat and the floor, making for a safer transfer onto the commode.
Rehabilitation professionals need to consider each individual's inherent worth and uniqueness and their medical profile when assessing for intrinsic and extrinsic fall risk factors, as this will determine tailored and comprehensive treatment plans inclusive of multi-treatment approach-based interventions, home modifications, and recommendations for DME, AD, and AE.