Click HERE to download this document separately, or read below.
We have attached below an independent report carried out by Abir
Mullick of the State University of New York at Buffalo. We
acknowledge and are very grateful to the author for highlighting
the difficulties incurred by senior bathers.
His report clearly states that more drownings occur with the over
60’s in the bathroom then in the swimming pool. It also gives
figures of bathroom accidents and all the preventative measures that
can be taken.
Here at Access Walk in Baths we are very aware of his findings
and we already incorporate most of his recommendations in our Bathtubs.
After you have read the report I am sure you will agree that fitting
an Access Walk in Bathtub will help to prevent any accidents,
enhance your quality of life and definitely give you peace of mind.
Introduction
The fundamental purpose of bathing is to maintain health and
physical well being of the body. While most young, able-bodied
people do not think twice about taking bath, bathing is more
difficult, more time consuming, and more hazardous for older people
with disabilities. The Gallup organization in 1983 surveyed 1,500
non-institutionalized people over the age of 55. "Using shower or
tub" was one of the sixteen problem areas identified for maintaining
activities of daily living. The National Center for Health
Statistics in 1987 reported that about 10 percent of all people over
the age of 65 have difficulty bathing, and about 6 percent receive
help (Lawton, 1990). The magnitude of problems older people
experience while bathing and the seriousness of the situation raises
many important questions. Why do they continue to bathe? How
difficult is it for older people to bathe? How safe is bathing for
older persons with disabilities? Why do older people bathe in unsafe
conditions?
Physiologically, bathing allows cleansing of the skin and removal of
accumulated foreign matter. Bathing displaces dead skin, prevents
irritations and rashes that would otherwise transform into
infections, and washes away waste materials that can interfere with
the normal functioning of the skin. Bathing allows people to: 1)
maintain acceptable social standards of cleanliness, both appearance
and olfactory, and 2) refresh, revive, and relax through the washing
process.
Bathing, like all forms of body cleansing activities, is habitual
and ritualistic. It is laden with social, psychological and
philosophical overtones. Philosophically, bathing is equated with
cleanliness of body and purity of soul, and it reflects aptly in the
popular phrase, "Cleanliness is indeed next to Godliness." People's
obsession to maintain a clean body is well known. Americans take at
least seven baths a week. The rising sale of deodorants, anti-perspirants,
and mouth washes supports the social emphasis for maintaining a
clean body, and it reflects the cultural and aesthetic spirit of the
society (Kira, 1966).
This paper will first examine the safety aspects of bathing. It will
then present results of a study that investigated the safety and
accessibility needs related to bathing among older persons and their
care-providers. Finally, the conclusion will offer design directives
to assist in design of a safe and accessible bathing equipment.
The Magnitude of the Problem
Accidental Deaths
Advocates of bathroom safety are astounded by the high incidence of
bathing-related deaths. ABT Associates Inc.'s report to the Consumer
Product Safety Commission in 1975 indicated that many as 70 persons
over the age of 65 die of bathtub-related burn injuries every year.
According to the National Safety Council, one person dies everyday
from using bathtub/shower in the United States. Of the 24,000
accidental deaths of people over the age of 65 every year, many are
bathing related (Burdman, 1986). The National Safety Council
reported that 345 people of all ages died in bathtubs in 1989, 364
in 1988, and 348 in 1987. Bathtub related deaths during the
three-year period exceeded those due to handgun accidents, all forms
of road vehicles accidents (excluding motor vehicles), ladders and
scaffolding falls, and ignition of clothing. Because bathtub related
deaths occur suddenly and in a supposedly protective environment,
these deaths tend to cause a greater degree of psychological trauma
for the families.
After the swimming pool, the bathtub is the second major site of
drowning in the home. Budnick and Ross (1985) studied
bathtub-related drownings between 1979-1981. They concluded that
those with least control over their environments - young and the
elderly -have the greatest risk of drowning. Children less than 5
years old accounted for 25 percent, and those over the age of 75,
15.5 percent of the bathtub-related deaths. Drowning deaths, for
those over the age of 60, were primarily due to having fallen in the
tub. Among children less than 5 years old, about 16 percent of
the deaths were due to being left unattended. Bathtub-related
drownings cut across age, sex and race barriers,. All people are
prone to deaths in the common household bathtub. Females accounted
for 52 percent, Whites 80 percent, and Blacks 17.3 percent of the
all bathtub deaths. Seizure disorder was attributed as the most
common cause of bathtub drowning among persons aged 5-39.
Bathing Injuries
On an average, 370 persons of all ages sustain injuries from
bathtub/shower daily in the United States. The dangerous aspect of
bathing is evident from the injury data reported by the Consumer
Product Safety Commission: 117,230 bathtub/shower injuries in 1989;
136,616 in 1990; and 139,434 in 1991.Those between the ages of 25-64
accounted for 37 percent of all bathtub/shower injuries; the most
vulnerable being those closer to the upper age limit. The elderly
accounted for 17 percent of bathtub/shower injuries in 1989, 22
percent in 1990, and 20 percent in 1991. More elderly people were
injured from using bathtub/shower than from other potentially
dangerous equipment such as exercise equipment or cooking appliances
(ranges or ovens).
No room at home poseses more threats to safety than the bathroom
(King, 1992; Koncelick 1982 ; Kira, 1966). The National Safety
Council reports that in 1990, "7.8 percent of all injury episodes,
or 4,547,000, involved persons of age 65 or older" (Accident Facts,
1992, p23). The majority of the accidents took place in and around
the home. About 30 percent of all home accidents are due to falls,
the sixth leading cause of death. Falls result in 200,000 hip
fractures, and 25 percent of all hospital admissions for people over
65. The bathroom is the primary location where many falls take
place. Confined space together with hard slippery surfaces create
great risk for all people, irrespective of their age or physical
condition. The greatest danger in the bathroom is slipping and
falling when entering and exiting thebathtub or shower. The hardness
of the bathtub surface and sharp, protruding fixtures are the chief
agent of injury in slips and falls. The lack of support surfaces for
grasping in older bathtubs is the primary reason why people slip and
fall. This is particularly true for older homes, a place where many
of
America's elderly reside.
Inconvenience
The results of a study published by the National Institute on
Disability and Rehabilitation Research indicates that in 1984 more
people were dependent in bathing than they were in dressing,
transferring into and out of bed/chair, meal preparation or
performing light house work (NIDRR, 1992). Bathing related
difficulties escalate sharply with age. They vary greatly between
the young-old(65-74), the old-old (75-84) and the very-old old
(85+). About 40,000 young old people reported difficulty with
bathing. There were twice as many old-olds and over five times as
many very-old olds who had problems with bathing. Not all people
experienced the same type of difficulties; some had more problems
getting in and out of the bathtub, while others had difficulty
adjusting the flow and temperature of water.
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(walking) . . . ADL and mobility difficulties affecting the
greatest number of elderly were bathing (2.5 million or 8.9
percent)" (NIDRR,1992, p66). Not all individuals with bathing
difficulties required help; about 252,000 people bathed unassisted;
1.4 million individuals required human assistance; 308,000 were
dependent on the use of bathing aids and equipment; and 280,000
needed both.
Safety problems among the aged are generally due to the loss of
physical capabilities and poor design of bathing equipment. In order
to compensate for loss of capabilities, the elderly tend to
over-exert themselves. This seriously affects their security and
personal well being. For example, the elderly have difficulty
bending over and kneeling down. They are unable to access parts of
their body when standing, and some even when sitting. Many attempt
to challenge their capabilities to access difficult areas and injure
themselves. The elderly are constrained by limited reach and poor
grip strength. They feel exerted by the poor design and location of
controls. They have problems reaching fixtures and grasping them.
Many receive injuries from applying excessive force. Poor balance
affects stabilization. This escalates their chances of slippage and
falling when entering and exiting the bathtub or shower.
Current Design
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. The earliest known bathtub dates
back to the Minoan dynasty in 1700 BC, and its form is almost
identical to the bathtub forms that are in use today. The present
day bathtubs are much like the Minoan tub, the only difference being
they are made of manmade materials and have flowing hot and cold
water. Showers are relatively new. The earliest showers were
developed for medicinal purposes (e.g. water cure or rain bath) in
the early 1800s. Showers became common with the introduction of
indoor plumbing. Their design has remained virtually unchanged since
the end of the first World War.
There are many problems with the present designs of bathtubs and
showers. First, these products are outdated and they fail to meet
the physical needs of the aging population. Adaptive fixtures
and equipment are "Band-Aid" solution to complex problems not
satisfied by conventional showers and tubs. They highlight failures
in conventional design and unresolved problems. Grab bars make up
for the absence of adequate support and the need for greater
physical security in the bath area. Bath mats overcome the danger of
the slippery floor surfaces. They reflect the need for safer
footing. Bath seats are a reminder of people's inability to stand
while bathing. They point the need for alternative ways of bathing.
Second, bathtubs and showers are ability-specific products. They
conform only to the functional capabilities and physical needs of
young, able-bodied individuals, and place considerable physical and
mental demands on the elderly, the children and those with
disabilities. For example, the positioning of controls and
accessories often require standing and a wide range of motion.
Bathtubs and showers require good balance when transferring in and
out of them. Third, the design of bathtub/showers do not reflect a
lifespan perspective. Conceptually, children begin to bathe on their
own by the time they are 6 to 7 years old. They continue to do so as
grownups until they are about 50-60 years old. Beyond this age, they
begin to inherit equipment-related dependence, followed by
people-oriented dependence, and finally dependence on both. Bathtubs
and showers do not meet the changing needs of people. They are not
responsive to adaptation as people's functional capabilities and
physical conditions undergo age-related changes. For example, when
unable to stand and bathe, people sit down while bathing. The loss
of reach from a person's restricted movement makes controls and
accessories inaccessible. Thus for much of their lives, people
either bathe in unsafe conditions or they are dependent on
assistance.
The Study
Purpose
The present study was conducted to assess the bathing needs and
preferences of older persons living at home, and their
care-providers. It was designed to generate qualitative data on
bathing, and it was aimed at understanding a variety of bathing
issues. The results of the study are being used to design a bathing
facility capable of providing greater safety and access to all.
Subjects
All together 40 participants (26 bathers and 14 care-providers) were
interviewed for the study. All bathers were over the age of 62, with
the exception of one 45 year old paraplegic male. The oldest person
was a 90-year old female. The interviewees consisted of: 20
independent bathers (those who bathe on their own), 6 dependent
bathers (those who are bathed by another individual), 3 family
care-providers (persons who bathe their relatives/friends) and 11
homecare-providers (professionals who bathe clients). Only three
participants had mobility problems; two depended upon the use of a
walker, and one was a wheelchair user. With the exception of the
paraplegic male, who received assistance from his wife once weekly,
all independent bathers managed on their own. The four dependent
bathers were assisted by care-providers. All of the bathers live in
non-institutional settings, most of them in apartments, some in
their own homes, and a few in housing projects for senior citizens.
The family care-providers are members of a care-provider support
group. The homecare-providers are employed by three health care
agencies, and their involvement was suggested by their respective
employers. All participants (bathers and care-providers) were from
the Buffalo area, and their participation in the interviews was
voluntary.
Methods
The field research was based solely on three categories of
interviews: focus group interviews consisting of four to seven
participants, personal interviews with bathers and joint interviews
with dependent bathers and their care-providers . The ambulatory
bathers (independent) were contacted through senior centers, and
they were interviewed in focus group settings in the senior centers.
The non-ambulatory bathers (independent and dependent ) were clients
served by long-term care agencies. They were interviewed in their
homes (some with aides and others without). The family
care-providers were interviewed individually in their homes.
Professional aides were interviewed simultaneously, with or without
their clients, in focus group settings at their offices or in their
clients' homes. The focus group interviews lasted between
one-and-one-half to two hours, the personal interviews between
three-quarters of an hour to an hour, and the joint interviews
between an hour and one-and-one-half hours.
All interviews were audio-taped. The bathrooms of those people
interviewed in their homes were video-taped. Each of the interviews
was conducted in a discussion-like situation using a variety of
open-ended questions. Due to the uniqueness of each person's
background and the personal nature of the discussion topic, not all
participants were asked identical sets of questions. Instead,
questions followed the momentum of the discussion and responsiveness
of the interviewee(s). They revolved around a set of pre-determined
bathing themes. The videos were later reviewed to determine the
environmental conditions of the bathrooms. The content of the
interviews were evaluated based on the quality and frequency of
responses received . The similarities, differences and uniqueness of
the information helped develop a pattern of bathing needs
andpreferences.
Findings
BathingDependence
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. Several
persons, in spite of as many as seven disabling conditions bathed
independently. All three mobility-impaired persons bathed
independently. An 80-year-old who lived independently in her own
home was dependent on being bathed. While another person who had
difficulties living independently, bathed on her own.
Bathing dependence generally resulted from illness and/or injury.
For example, a 90-year-old mother's dependence was due to falls in
the home, and an 80-year-old woman's dependence resulted from a
physical injury. No individual was completely dependent on being
bathed. They all offered various levels of assistance. For example,
one person who required help with soaping, rinsing and drying,
transferred on her own. Another person who only needed help in
transferring in and out, bathed mostly on her own. Bathing
dependence was both physiological and psychological. For example,
one person phoned her daughter before and after her bath. Another
person has her care-provider remain present in the bath area at all
time. A 90-year old mother made sure that her daughter stood outside
the closed bathroom door. People's ability to bathe on their own
depended on age, severity of disabling condition(s) and their
willingness to do so.
Mechanical and Physical Difficulties
Bathing difficulties vary significantly. The most common problem was
maintaining balance when bathing and making transfers. Those unable
to make safe transfers had abandoned tub-oriented bathing. Other
problems were largely due to inadequate reach, poor grasp and low
level of thermal sensitivity. Many individuals indicated that
because of their inability to "reach low," using controls from the
outside of the tub was impossible. Opening faucets and adjusting
water temperature are troublesome for many. Those who lack sensation
in the hands frequently misjudged the water temperature and got
scalded. Low level of illumination made it difficult for bathers to
see controls and accessories. In the absence of auxiliary heating,
people felt cold while bathing. Inadequate storage caused laying
around of articles. This made it impossible to keep the bath space
organized. The size of the bathing space presented diametrically
opposite problems. Small size restricts movement of wheelchair users
and those providing care. Excessively large space makes controls and
accessories inaccessible, and wheelchair users become fatigued from
wheeling around in an attempt to reach for accessories.
Accessible showers, specially built to provide a greater degree of
convenience, are not free of problems. Several users of accessible
showers indicated that they have trouble using controls and bathing
accessories while sitting on built-in seats. Consequently, many of
them were either forced to stand up with water running to reach for
accessories, or store them on the seat. One individual had installed
a transfer bench and a flexible hose to combat the reaching
difficulty. Another individual who has a paralyzed right side, had
no use of the grab-bar (since it was located only on the right
side). In the absence of a bar on the left side, getting out of the
shower safely was difficult. A third person, a lower limb amputee,
found it impossible to make transfers to and from the built-inseat.
She used a transfer seat to get in and out of the accessible shower,
and used the built-in seat to hold accessories.
A majority of persons have difficulty using integrated level type
controls.Even though they felt it was easier using such a control,
the difficulties were due to: 1) the problems of understanding the
color-coded signage for water temperature and flow, 2) the complex
operational demands of the faucets requiring two simultaneous
actions,push and turn, or pull and rotate, 3) the non-standard
nature of these operations. Those with tremor of the hand or
arthritis in the hand were unable to fine-tune the temperature and
flow adjustments.
Practically all care-providers indicated that bathing people is the
hardest task for them, and getting people out of tub is the most
difficult part of the task. They reported that narrow passages and
awkward layout of bathrooms make it difficult to handle clients with
side-by-side movements. They also obstruct the movement of persons
with mobility aids. Inadequate space in the bathroom makes it
difficult to roll-in wheelchairs. According to homecare-providers,
most clients have great difficulty accepting bathing-oriented
assistance from other people. They felt that gaining clients' trust
and cooperate in the bathing process are the most difficult part of
their job. They complained about sliding glass doors and how they
pose great difficulty in transferring people in and out of the tub.
Some of the other difficulties they mentioned included:
•lack of space between tub and adjoining fixtures,
•inadequate space around the tub,
•unavailability of a proper transferring device,
•slippery floor conditions,
•inadequate lighting,
•excessive postural stress resulting from bending over,
•client's unwillingness to be bathed,
•client's ability to assist, and
•fatigue of bather. Care-providers find it difficult to shower
clients in a shower stall because they themselves become completely
drenched.
Unsafe Practice
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. Some people had stored
accessories on the bathseat, thereby decreasing the seating area and
increasing the chances of sliding off. An individual who walks with
the help of a walker adopted a series of very dangerous methods to
make transfers and regulate water temperature. While transferring,
he did several complex tasks simultaneously while holding on to the
walker with one hand and grasping the wall-mounted grab-bar with the
other. He then lifted, dragged and bumped his legs up against the
tub. While his hands tremble from the excessive force, he
transferred one leg at a time into the tub. The method he adopted
for adjusting the water temperature is equally dangerous. He
operated it by kneeling down on the narrow floor space between the
tub and the toilet, grasping the walker with one hand, extending
himself over the rim of the tub to reach the controls. The lighting
level in the tub was also very low.
Numerous individuals observed unsafe bathing practices and
jeopardized their safety and well being. For example, by placing
throw rugs outside the tub, many individuals encouraged tripping and
catching their walker/cane. Objects scattered around the bathroom
constituted hazards for everyone, especially those with visual
impairments. One individual admitted hanging on to the bathroom door
and the sink to make transfers. Another person who had difficulty
reaching the controls from outside the tub, regulated the water
temperature from the inside and often got scalded. A care-provider
bathed her 90-year-old mother in a tub that had no grab-bars. The
tub was equipped with sliding glass doors. When stepping in and out
of the tub, the mother leaned on the glass doors.
Common Accidents
Bathing-related accidents are due to the physical and mental stress
that both care-providers and clients experience. These problems are
compounded by medication and fatigue from heat. Several individuals
had either fallen or come close to falling in the bathroom. An
individual who has hip problems and arthritic knees, was unable to
get up after a tub bath. She sat on the tub floor for thirty
minutes, rolled over the tub edge to grab the sink, and dragged
herself out of the tub. Many people have reported falling into the
tub while arising from the toilet seat . One of these people used
her emergency beeper for assistance and was rescued by her family.
Although none of the participants were ever severely scalded, many
have been and continue to be mildly scalded because of poor
sensation of the hands.
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, a large majority 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 themselv es to make bathroom
modifications. Older residents are generally uninformed about the
type of technical assistance they need andwhere to look for it. They
see modifications as an acknowledgment of their own disabilities and
they are embarrassed by it. They think modifications will effect 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 was 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.
Many family care-providers experience very high levels of mental
stress from providing care to their relatives. Emotional stress is
the most difficult part of being a family care-provider, who
sometimes are themselves older and have other family
responsibilities. In addition to looking after other family members,
many work outside their homes as well. Consequently, they feel
pressuredto meet their obligations. Most of them are exhausted from
providing constant attention and are burdened from having to contend
continually with family care. Often, lack of acknowledgment from the
one receiving care greatly escalates the level of emotional stress.
Client-related stress varies with:
•size, shape and physical condition of the client, and •the level of
nervousness, cooperation, and willingness the client may display
during bathing.
Environment-related stress is dependent on:
•the availability of transferring devices, and •physical features of
the bathroom such as the tub height, presence of sliding glass
doors, bathroom layout, narrow width of clearances, floor conditions
and low lighting level.
Care-provider related stress is a function of height, weight and
physical condition of the care-provider, and the time pressure
resulting from trying to complete all tasks quickly.
Conclusion
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. To provide greater stimulation,
control and personal empowerment for bathers and care-providers, the
following design principles should be observed when making
modifications to existing bathrooms and the design of the future
bathing equipment. It is important that individuals consult their
therapist and evaluate their needs before making modifications or
purchasing devices.
1. EnhanceSecurity
Bathing safely and with comfort is largely an environmental issue
and is guided by the quality and physical characteristics of the
environment. As we know, the incidence of falling while bathing
threatens all persons regardless of age but specially those with
poor balance. In addition, falling while providing care threatens
the safety and well being of care-providers.
Recommendations for Existing Bathrooms:
•Emergency Rescue Devices
Install emergency devices such as telephones or intercoms within
effortless reach of the users. These devices provide greater
personal security. They can alert monitoring individuals about
accidents, advise accident victims about how to get out of a crisis,
and help individuals in the rescue operation. •Better Illumination
Low illumination together with poor vision makes it difficult to
detect articles scattered around. Better illumination will direct
attention to potential threats fromprotruding objects and other
hazardous conditions. This can be achievedthrough:
•additional light source in the bath area, •natural daylight via
appropriate size window, •light colored walls in the bathroom, and
•using a transparent curtain.
•Storage
Accessories laying around create hazardous bathing conditions.
Provide greater storage space through wall mounted shelves. This
will prevent accidents from bumping objects into and skidding from
articles scattered around the floor.
Recommendations for New Bathing Equipment:
•incorporate easy to use rescue device and locate them in a
strategic position
•consider smart devices that will alert the central monitoring
system at the time of an emergency •build-in lighting fixtures into
the design of the equipment
•allow for adjusting the illumination level
•offer a choice of direct or diffused lighting
•build-in storage into the design of the equipment
•enable individuals to alter the location and size of storage
•round all edges and soften all corners to reduce the chances of
injury in a fall
•give a safe appearance to the surroundings through recessed
fixtures and rounded edges
•install anti-scalding device
2. Making Safe Transfers
Getting in and out of the tub is the most critical aspect of bathing
independently. It is also the most difficult aspect of providing
care. Poor balance and fear of falling greatly affects people's
ability to make safe transfers. Awkward tub shape, inadequate
maneuvering space and slippery floor conditions greatly adds to
problem.
Recommendations for Existing Bathrooms:
•Transfer Bench
Install transfer bench for making easy transfers. These benches
generally remain partly inside and partly outside the tub. A 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.
•Grab Bars
Mount grab bars in the critical support areas. They can greatly
assist in easy and safe transferring in and out of the tub. Grab
bars come in various designs: horizontal, vertical, diagonal, hockey
stick like, combination, wrap-around, swing away or detachable. Grab
bars can be wall, floor, ceiling or tub mounted. Ridged, brushed,
knurled or vinyl coated grab bars provide better grasp. Because
people's physical capabilities and method of transfer vary
significantly, their placement must accommodate unique requirements
of users. In addition to following codes, the positioning of grab
bars must be carefully tested under actual operating conditions.
Recommendations for New Bathing Equipment:
•eliminate the need for making transfers in and out of the tub and
the hazards caused by the activity
•use mechanical devices such as bathlifts before offering human assistance
•provide a build-in transfer device for those who need it
•explore alternative, non-threatening soaking possibilities that are
comfortable and less demanding
•locate grab bars at strategic points
capable of facilitating transfers
•allow personalization of grab bars to meet unique needs of
individuals
3. Prevent Slipping Inside and Outside the Tub
Slipping inside the tub happens due to the smooth condition of the
wet tub surface. When getting out, slipping is caused by the smooth,
wet floor surface. Lack of hand rails further contributes to the
problem.
Recommendations for Existing Bathrooms:
•Non-Slip Tub Floor
Non-slip tub floors can greatly add to the security of the bathers
and care-providers. Install bathmats, tub patches or non-skid
surface in the tub. Bathmats are rubberized floor coverings and they
fit inside the tub. They are placed temporarily and can be removed
for cleaning and/or repositioning. Unless they have suction cup-like
backing, many bathmats tend to get loose and slip. Bath patches are
small non-skid pieces. They are inexpensive and need to be
permanently glued to the tub surface. Non-skid tub surfaces are
integral part of the tub floors and they cover the entire floor
surface.
•Non-Skid Bathroom Floor
Carpet the bathroom floor or place a thick variety of throw rug
outside the tub. Even though carpeting is more effective than throw
rugs, it is generally harder to maintain. Thicker throw rugs are
more slip resistant than thinner ones. The floor underneath the rug
must be dry and free of unwanted objects. When stepping on the rug,
individuals must not rely solely rely their balance. They must use
hand rails to support and distribute their body weight.
•Grab Bars
Install grab bars outside the tub. Because slip prevention depends
greatly on the quality of the support, it is important that
attention is paid to the selection of the grab bars and their
placement is carefully studied under actual conditions of use.
Recommendations for New Bathing Equipment:
•incorporate permanent, non-skid tub floor surfaces into the design
of bathtub
•extend same non-skid floor outside the tub
•install widespread distribution of grab bars in the form of
handrails
•provide "invisible support" that offers assistance when needed
•strengthen soap holders or towel rods so that they can act as
invisible supports
4. Prevent Over-exertion
Over extension can be attributed to poor design of the physical
environment and to an individual's psychological state of mind.
First, it is caused from labor of stretching for accessories and
controls that are not within easy reach. Second, over-extension is
caused by difficulty in reaching various parts of the body. Third,
individuals concerned with poor reach tend to challenge their
reaching capabilities and over-extend.
• Articles Within Easy Grasp
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.
• Handheld Fixtures
Locate manual fixtures such as hand held showers to combat the
difficulties due to inflexible positioning of tub/shower controls.
Such fixtures will greatly increase access and prevent physical
strain from over-extension.
• Bathing Devices
Devices such as wash mittens and bath brushes can greatly increase
access to parts of the body. The wash mittens are usually made out
of terry cloth, plastic mesh or soft sponge. Bath brushes are
available in long, short or curved handles. They come with cloth
head, sponge tip or nylon bristles. Wash mittens and bath brushes
provide a person a great range of access and bathing independence.
•Plan Ahead and Take Time
It is essential that people plan ahead for the type of accessories
they need before plunging into the bathtub. Make sure towels, soap
and shampoo are within easy reach. Bathing in a hurry can seriously
jeopardize safety. Allocate enough time to make transfers and when
reaching for articles. This will decrease psychological stress and
increase bathing pleasure.
Recommendations for New Bathing Equipment:
•locate accessories and controls within easy reach
•allow making easy adjustments to meet the changing needs of people
•built-in hand held fixtures into the design of the equipment
•remove all loose, add-on fixtures such as bath seat and bathmat,
and replace them with secure built-in products
Bathing independence for the elderly requires taking several
considerations into account. For example, personalization of the
bathing environment , on the one hand provides independence. But on
the other hand, it is unsuitable for people's general use. Custom
design environments is particularly beneficial for those with
disabilities. They provide maximum utilization of individual
capabilities, enable a high degree of independence, and offer a
great deal of self-control. Adaptability of the bathing environment
will respond to the needs of a great variety of individuals, allow
making easy adjustments as people's needs and preferences change,
and address individual differences based on age, sex and physical
conditions. It will also provide a wider range of options, transform
itself easily to a variety of situations (i.e., for wheelchair use
and those not confined to use wheel chair use) and adjust to various
space limitations (i.e., older bathrooms and newer construction).
Simple design of the bathing equipment is the key to safe and
efficient use of the product. In the case of the elderly, simplicity
is synonymous with age-sensitivity. It requires avoiding complicated
gadgetry, removing physical demands that contribute to emotional
stress, and utilizing easy-to-use mechanical means of assistance.
Cultural compatibility of bathing fixtures is essential to providing
safety. Older people, by the virtue of their social and
technological beliefs represent a subculture known as "traditional."
Design for the elderly, therefore, must respect their background and
their cultural needs. The difficulties people have with lever-type
controls as explained in the finding is typical of cultural issues
designers must consider when developing a product environment for
them. Straight forward ergonomic solutions designed for human
convenience must to be examined against the backdrop of their
socio-cultural beliefs. Cultural compatibility will greatly
influence the usability and social acceptability of designed
products. It can be achieved through respecting the technological
understanding of individuals, paying attention to how people make
decisions, and valuing their cultural backgrounds
Accessible design should not be the exclusive domain of the majority
of the older and disabled population - it concerns everyone. Because
the elderly live with people of different ages, sexes and physical
conditions, and reside in homes where the bathroom is shared by
others, a safe bathing facility should not focus solely on their
exclusive needs. It is vitally important that the design of a the
new bathing equipment adopt a lifespan - all ages- approach to
product development. Such an approach will eliminate the need for
"special design" situations that result in a mismatch between the
user's needs and the confines of the environment . It will also
prevent making costly retrofits and rehabilitation of obsolete
structures. The life span approach will allow the product to adapt
to the continually changing needs of people and prevent millions of
individuals from bathing under unsafe conditions. In summation, a
universal design responsive to the lifetime needs of all people,
will ensure greater use, safety, privacy, independence and dignity.
It will meet both the physical and psychological needs of people of
all ages through their entire lifetime.
References
Burdman, G. Healthful Aging, Prentice-Hill, New Jersey, 1986.
Budnick, L., Ross, D.Bathtub-Related Drownings in the United States,
1979-81. American Journal of Public Health, 1985 Vol. 75, No. 6.
King, Vanessa.Safety Zone. Continuing Care, March 1992.
Kira, Alexander. The Bathroom: Criteria for Design, Cornell
University, Ithica, NY1966.
Koncelick, Joseph. Aging and the Product Environment, Hutchinson
Ross, Stroudsburg, PA,1982
Lawton, M. Aging and Performance of Home Tasks. Journal ofthe Human
Factors Society, 1990; Vol. 32, No. 5:527-536.
National Institute on Disability and Rehabilitation Research, Digest
of data on Persons with Disabilities, Washington D.C.,1992
National Safety Council, Accident Facts, 1992Edition
U.S.Consumer Product Safety Commission, National Injury Information
Clearinghouse, Washington D.C.
Other Articles Available for Free
Automated Doors: Towards Universal
Architectural Barriers to Normalization: The Acoustic Environment of Group Homes
Hyperhomes: A Technical information Manager for Home Modification Service to Older People
Enabling Home Environments: Strategies for Aging in Place
The Concept of Universal Design |
