Bath falls common among older adults, but can be prevented

Installation of proper equipment essential

ANN ARBOR, Mich. -- Getting in and out of the bathtub or shower can be a perilous journey for older adults, even when they have bathrooms already equipped with safety features, according to research by the University of Michigan Health System.

Researchers videotaped people ages 60 and older who demonstrated (while fully clothed) how they normally climbed in and out of the shower or tub. One-third of the 89 participants in the study had difficulty, such as plopping onto a tub seat or hitting the side of the tub or the shower threshold with their legs.

"We found that there are a lot of independently bathing older adults who have trouble or are unsafe getting into and out of the tub or shower stall," says lead author Susan L. Murphy, ScD, OTR, an occupational therapist and research assistant professor with the University of Michigan Medical School's Division of Geriatric Medicine, part of the Department of Internal Medicine. The study appears in the Journal of the American Geriatrics Society.

"For older adults, losing the ability to bathe is associated with having falls, fracturing bones, and even being admitted to a nursing home. It is important that we take steps to help to prevent bathing disability before it occurs," Murphy says.

One of the major problem areas the researchers found involved sliding glass doors in showers. Three-quarters of participants who used shower stalls with sliding glass doors tried to utilize the door for stability or balance.

"This is extremely unsafe because shower doors were not designed to support a person's weight," Murphy says. "This problem could be easily remedied by educating older adults not to use the door as a support or possibly replacing it with a shower curtain, which was used only rarely by older adults in this study."

Participants in the study were residents of two congregate housing facilities and had no cognitive impairment. They were videotaped as they demonstrated how they used their environment while getting into and out of the shower or tub that is, whether they used grab-bars, towel bars, shower curtains, glass doors, tub seats, and other parts of the tub to assist themselves.

The videotapes were also evaluated for the participants' fluidity of movement and whether they had difficulty negotiating the environment. While the majority of people using both tubs and shower stalls used safe environmental features such as grab bars, many used unsafe features in addition to the safe ones. Nineteen percent of participants using a tub were evaluated as using unsafe features, and more than 70 percent of those with shower stalls used unsafe features, such as the glass door, towel bar or a tub seat. One participant had a plastic lawn chair as a tub seat, a particularly dangerous device given curved shape of the tub floor.

Some safety problems researchers observed can be fixed easily such as the installation of a shower curtain in place of a door, and proper instruction about built-in bathroom safety features (such as grab bars designed for weight-bearing) for new residents of senior housing facilities. A focus on better designs of bathrooms in senior housing facilities was also suggested by the researchers.

"We think the results from this study demonstrate the need for healthcare professionals to become involved in helping to prevent bathing disability, instead of just treating people in the hospital after they have had a fall in the bathroom," she says. "While bathrooms in senior housing facilities are designed to be safe, we have found that older adults often do not know the difference between a grab bar and a towel bar. They also have unsafe strategies of getting into and out of their shower or tub. Occupational therapists often see older adults for bathing problems and would be ideal to intervene with older adults before they start to lose the ability to bathe."

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In addition to Murphy, the authors on the paper were Neil B. Alexander, M.D., professor in the Division of Geriatric Medicine, Department of Internal Medicine, and director of the Geriatric Research, Education, and Clinical Center, VA Ann Arbor Health Care System; Linda V. Nyquist, Ph.D., senior research associate-social sciences, Institute of Gerontology; and Debra M. Strasburg, M.S., P.T., research physical therapist, VA Ann Arbor Health Care System.

The research was supported in part by grants from the AARP Andrus Foundation, the Department of Veterans Affairs Office of Research & Development, and the National Institute on Aging (NIA) Claude Pepper Older Adults Independence Center. Murphy is a recipient of a K01 Mentored Research Scientist Development Award from the National Center for Medical Rehabilitation Research, and Alexander is a recipient of a K24 Mid-Career Investigator Award in Patient-Oriented Research from NIA.

Citation: Journal of the American Geriatrics Society, Aug. 2006, "Bath Transfers in Older Adult Congregate Housing Residents: Assessing the Person-Environment Interaction."


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