Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 490

As with urinary incontinence, the ability to defecate at a time and place of one’s own choosing relies on both physical and cognitive function. Locating suitable facilities requires integrating visual information to identify and visuospatial and executive function to plot a route to those facilities. The person will then need to rise, ambulate, disrobe, and sit before defecation can occur. A disorder that impairs these processes and their integration, including visual impairment or unfamiliar or poorly signposted toilets, such as those found in hospitals and care homes, will make it more challenging to locate facilities; and impairments to mobility, through sarcopenia, arthritis, or neurological conditions, including stroke, will make both reaching the toilet and getting into position to defecate more challenging and potentially lead to faecal incontinence. Unsurprisingly, faecal incontinence is more prevalent among nursing home residents than any other group.⁴ Walking aids such as frames can also impair the ability to access facilities, and adaptive devices such as raised toilet seats cause the rectum to straighten, making defecation more difficult.