This study aims to identify safety issues for older adults during transfers in and out of the bath and shower. Participants were assessed for physical functioning and observed during a bath transfer. Researchers identified the types of supports (e.g. grab bars, towel bar, side of tub) that older adults use during bath transfers, and determined the level of safety of the supports. The study results call attention to the need to design bathroom environments that promote safe transferring into the tub or shower. Useful interventions from health care professionals might include removing sliding glass doors and other bathroom hazards as well as providing training to older adults on how to safely transfer in and out of the bath and shower.

Background: Older adults who have difficulties bathing independently have an increased risk of hospitalization, nursing home admission, bone fractures and death. Transferring into and out of the bathtub or shower is one of the most difficult bathing activities for older adults. When transferring into the bathtub or shower, it is common for older adults to require some kind of support, such as a grab bar, to hold onto during the transfer. This study evaluates the different ways that older adults transfer into and out of the tub or shower, and attempts to determine the characteristics of individuals who have difficulties with the transfer as well as the supports available in their bathrooms. The goal of this study is to identify safety issues and problems with physical functioning, the bathroom environment, and/or individual bathing strategies that could be improved in order to increase the safety of older adults' bath transfers. Methods: Participants in the study were 89 adults over the age of 60 living in congregate housing in Michigan who did not have any cognitive impairment. All participants reported that they bathe independently. Participants were asked to undertake two observation sessions: one in their home and one in a laboratory space. During the first session, researchers observed the bathroom environment of the participant and video-taped the participant as they performed a bath transfer. Researchers then observed the video tapes and assessed the level of difficulty the participant had during the transfer. Researchers looked for the types of supports the participant used during the transfer, such as grab bars, towel bars, shower curtains, glass doors, tub seats, parts of the tub and walls, and assistive devices. Researchers also looked for the participant's ease of movement and ability to negotiate their environment. The tape recordings were then coded based on the participant's performance difficulties. Coding categories included the following: falling onto the tub seat; hitting a bath surface with a lower extremity; making more than one attempt at getting into or out of the tub; physically lifting lower extremities over the tub side; and leaning against the tub surface while getting in and/or out of the tub. The second session held in a laboratory assessed the physical abilities of the participant based on self-report and a series of performance measurements. Physical ability was determined based on range of motion, lower extremity strength, functional mobility, and fear of falling.

Findings: The average age of participants was 83 years. Twenty-three percent of participants had a history of joint replacement, 45% used a cane or walker at least some of the time, and 12% reported having difficulties with bath transfers. Approximately half of the participants used a shower stall and half used a tubshower. Roughly a quarter of participants regularly used a tub-seat in their shower or tub. Throw rugs and towels on the floor were the most commonly observed environmental hazards in the participants' bathroom. On average, participants used two supports to help them transfer in and out of the tub. Grab bars were the most common support used, and also the safest of the observed supports. The most prevalent unsafe support was the sliding glass door followed by the towel bar. One-third of the participants experienced at least one difficulty during the transfer. The most common difficulty was falling or positioning into the tub or tub-seat. Participants with range of motion impairments and fear of falling had a higher likelihood of experiencing a difficulty during the bath transfer. Lower extremity strength was not associated with bath transfer difficulties.

Conclusions: This study revealed important challenges about the bath transfers of older adults that may not be obvious from simply observing their bathroom environments. Results call attention to the need to design bathroom environments that promote safe transferring into the tub or shower. Useful interventions from health care professionals might include removing sliding glass doors and other bathroom hazards, as well as providing training to older adults about how to safely transfer into and out of the bath and shower.

Reference: Murphy SL, Nyquist L, Strasburg D, Alexander N. Bath transfers in older adult congregate housing residents: Assessing the person-environment interaction. Journal of the American Geriatric Society. 2006; 54: 1265-70.

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