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Bathing For Older People With Disabilities

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 poses 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 the bathtub 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.


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 youngold( 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 agerelated 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.

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