Bathing for Older People
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, especially 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 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).
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 drowning between 1979-1981. They concluded those 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.
Bathing Injuries
On 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 creates 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.
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.
http://www.bentleybaths.com/
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By George Bentley
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