Bathing for Older People - Part VIII
The risk of falling along with clients is a well known fear among care-providers. Yet, only one among those interviewed admitted having done so. According to the care-providers, if a bathing accident will usually occur under the following conditions: 1) toward the end of the bathing procedure since clients are both tired and relaxed at that time, 2) after a care-provider as been on a case for some time, because a client's ability to assist diminishes as his/her condition worsens, and 3) when transferring a client out of the tub, because the client's body is damp, the tub inside and the floor outside are wet and slippery, and the client and the provider are fatigued.
Unsafe Bathing Conditions
Even though a concern for safety is on the rise, large majorities of the elderly who live in older homes continue to bathe in unsafe conditions. In spite of all their difficulties, they make no modifications to their outdated bathroom, and expose themselves to unnecessary risk. There are several reasons why they make no environmental changes. During their early phase of functional decline, they simply make behavioral changes in the way they bathe, hoping that this will compensate for the lack of safety. Because a majority of them live on fixed incomes, retrofitting the bathroom is an economic burden they are unable to bear. Even if many individuals are willing to make modifications, the condition and layout of the buildings they live in do not lend themselves to make bathroom modifications. Older residents are generally uninformed about the type of technical assistance they need and where to look for it. They see modifications as an acknowledgment of their own disabilities and they are embarrassed by it. They think modifications will affect the value of the property and/or burden the successor with undoing them.
Present Safety Measures
Both individuals and care-providers do take precautionary measures to ensure safe bathing conditions. For example, most bathers and care-providers place slip-resistant bath mats inside and outside the tub to prevent skidding and falling. Those with grab-bars in the tub area hold on to these bars when bathing. Many people make sure that hotel bathrooms have grab-bars before reservations are made. Most people ensure safety by being very careful about every activity. Care-providers ensure safety by remaining vigilant and remaining with the person all the time. Home care-providers wear sneakers in the bathroom and ensure good illumination in the bath area.
Constant Stresses and Fears
Falling and colliding with hard, pointed fixtures were the most common of all fears. People were afraid of falling while standing in the shower, during transferring in and out of the tub, and while holding on to a grab-bar. Some were afraid of getting scalded because of misjudging the water temperature. One person had abandoned tub-oriented bathing because of her fear about not being able to exit.
Both care-providers and clients experience physical and emotional stress due to bathing. The most common stress is physical. People get tired during and after showering, and they experience shortness of breath. Non-ambulatory clients tire themselves easily from movement and from the level of activity that is demanded by being bathed. Most home care-providers get fatigued by bathing clients, assisting them during transfer, and from bending over. Many experience serious emotional stress. This is because they develop a family-like bonding with their clients. The emotional stress results from the personal nature of the service they perform and it is further heightened by the long hours of client contact and proximity they maintain.
Questions and Answers
Both individuals and care-providers frequently practiced unsafe methods while bathing or assisting with the task. This was due to not understanding the associated risk level. Standing while bathing in the absence of adequate grab-bars was the most common of all unsafe practices. Some people stood up to soap their underside knowing full well that they had a balance problem. Others reached out to grasp objects fearing they would fall.
Install transfer bench for making easy transfers. These benches generally remain partly inside and partly outside the tub. Persons would sit on the part outside the tub and gradually slide his/her body inside the tub. Transfer benches are available in various sizes and seat types. Some are height adjustable and come with or without a backrest. Benches with rubberized legs ensure safe positioning inside the tub.
Review of available bathtubs and showers suggests that safety was never the major issue in their design! Historically, the development of bathing equipment has been more of chance than conscious design. Institutional equipment has undergone a significant evolution because assisted bathing is very difficult for care-providers but, the design of common household bathtub/showers has remained virtually unchanged.
Bathing dependence varies greatly between people and their physical conditions. Ability to bathe independently did not depend on any one factor. For example, a 63 year old female with left sided paralysis, hip replacement and arthritis in the sacroiliac was dependent upon being bathed, while an 85-year-old woman with arthritis, impaired vision and shortness of breath bathed independently.
Safe and accessible bathing is not solely a concern of the elderly, disabled and those caring for them. It is of utmost importance to all people irrespective of their age, sex and cultural background. Eliminating accidental deaths and injuries is of prime importance in creating a safe bathing environment.
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Easy reach for bathers and care-providers is critical. To achieve this, position all accessories and controls within comfortable reach. Appropriately placed wall mounted storage greatly increase reach. Their placement must be carefully examined and the final location thoroughly tested on the basis of individual needs.
Bathing dependence varies greatly between people and their physical conditions. Ability to bathe independently did not depend on any one factor. For example, a 63 year old female with left sided paralysis, hip replacement and arthritis in the sacroiliac was dependent upon being bathed, while an 85-year-old woman with arthritis, impaired vision and shortness of breath bathed independently.
Most people prefer to soak in a tub when they bathe. But lack of safe lowering and lifting devices means that many older people, people with joint or muscles issues and heavier people can no longer soak. They lack the strength, flexibility and support to get up and down in the tub safely. Unfortunately, the desire to soak is so strong that many people create elaborate and risky processes to be able to continue to get down in the tub.
Review of available bathtubs and showers suggests that safety was never the major issue in their design! Historically, the development of bathing equipment has been more of chance than conscious design. Institutional equipment has undergone a significant evolution because assisted bathing is very difficult for care-providers but, the design of common household bathtub/showers has remained virtually unchanged.
Bathing is a difficult task for a large number of the America's elderly. Another study by the NIDRR indicated that in 1987, "a total of 3.6 million persons (12 percent in the community of over 65) had difficulty with at least one Activity of Daily Living or mobility and the mobility difficulties affecting the greatest number of elderly was bathing (2.5 million or 8.9 percent)" (NIDRR,1992, p66).
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