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Bathing For Older People With Disabilities


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. Enhance Security

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 from protruding objects and other hazardous conditions. This can be achieved through:
    • 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 person 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 handrails 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 smallnon-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 handrails to support and distribute their body weight.
  • Grab Bars
    Install grab bars inside and 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 pl an 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 bathseat 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 andthe 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.

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New York-Presbyterian. The University Hospitals of Columbia and Cornell