# Visual Search Behavior During Toileting in Older Patients During the Action-Planning Stage

## TL;DR

This study examines how older patients visually search for the toilet during rehabilitation, finding that gaze patterns correlate with their independence in toileting tasks.

## Contribution

The study introduces a novel analysis of gaze behavior during the toileting action-planning stage in older patients.

## Key findings

- Longer gaze time on the toilet seat correlates with greater toileting independence.
- Prolonged gaze on the toilet rim and handrail correlates with reduced independence.
- Gaze patterns may reflect compensatory strategies or visual salience responses in older patients.

## Abstract

Background: Visual search supports action planning and target selection in daily life. Despite toileting being frequent yet high-risk in rehabilitation, gaze analyses specific to toileting remain limited. This study quantified visual search behavior during the approach phase of toileting. Methods: Twenty inpatients aged 65 years or older in a convalescent rehabilitation ward participated in the study. At the time of hospital admission, their gaze behavior from toilet room entry to arrival at the bowl was recorded using an eye tracker (Tobii Pro Glasses 2). Moreover, we evaluated a toilet-functional independence measure (toilet-FIM), comprising toileting, toilet transfer, and locomotion at discharge. Results: In multiple regression, a longer total gaze time directed towards the toilet seat was associated with a greater toilet-FIM independence (β = 0.446), whereas prolonged gaze to the toilet rim (β = −0.839) and to the right handrail (β = −0.621) were related to lower independence (adjusted R2 = 0.715). Conclusions: A toilet seat-oriented gaze implies effective action planning for safe sit-down, whereas toilet rim- or handrail-oriented gazes may reflect responses to visual salience or compensatory visual strategies related to reduced independence. These observations could improve our understanding of older patients’ motor planning and spatial perception in toileting.