Home and Community Care Digest
Methods: Six hundred twenty six elderly people aged 73 and older, living in New Haven, Connecticut participated in this study. Participants were recruited by a team of trained research nurses who collected data on medical condition, cognitive ability, mobility, grip strength, and instrumental ADLs (such as shopping and managing finances).. The participants were asked about their difficulty/dependence in completing specific sub-tasks of bathing (obtaining and using supplies, taking off clothes, turning on water and adjusting the temperature, getting into the bathing position, washing whole body, leaving the bathing position, drying whole body, and getting dressed). Finally, participants responded as to why they needed assistance or had difficulty bathing themselves. Responses were categorized as follows arthritis or joint pain of hands, arms, or shoulders; arthritis or joint pain of hips, knees, or feet; back pain (all causes); balance problems or unsteadiness on feet; fear of falling, fall, or injurious fall; stroke, with weakness of an arm or leg; vision problems; fatigue, generalized weakness, poor endurance, or shortness of breath; memory problem or confusion; or any other reason or condition.
Findings: On average, the participants were 82 years old, 66% female, 90% Caucasian, modestly disabled, and mildly cognitively impaired. Most people bathed in the shower (75%) or tub (17%). Few people used sponge baths (7%) or other methods of bathing (less than 1%). Bathing disability was found in 31% of the participants. Of these, 15% reported the need for personal assistance and 16% reported difficulty bathing alone. Results indicated all sub-tasks of bathing were affected to a certain degree (obtaining and using supplies, taking off clothes, adjusting water controls, getting into bathing position, washing whole body, leaving bathing position, drying whole body, getting dressed). The two most common self-reported reasons for bathing disabilities were falls /fear of falling and difficulty with balance. Vision problems and weakness from stroke were relatively uncommon The elderly who were dependent on personal assistance with bathing had twice the average number of affected subtasks as those who had difficulty bathing. Memory and balance problems were more likely to be cited by the elderly who were dependent on others while bathing. Arthritis was the major reason cited by those who had difficulty bathing alone. While most participants (59%) reported more than one reason for bathing disability, only 8% cited three reasons.
Conclusions: Bathing disability occurs in one in three elderly people living in the community and can result from dependence or difficulty with a range of specific sub-tasks. Fear of falling, difficulty with balance, and arthritis were common reasons for bathing disability. Identifying reasons for bathing difficulty/dependence and affected bathing sub-tasks might be beneficial to home care agencies. Preventative and restorative actions could be developed in order to ensure that this important ADL can be continued to be completed independently by the elderly living in the community.
Reference: Naik AD, Concato J, Gill TM. Bathing Disability in Community-Living Older Persons: Common, Consequential, and Complex. Journal of the American Geriatrics Society, 2004; 52, 1805-1810.
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