Bathing adaptations in the homes of older adults (BATH-OUT): results of a feasibility randomised controlled trial (RCT)

Abstract

BackgroundHousing adaptations have been identified as an important environmental and prevention intervention for older adults, which may improve health and quality of life. The onset of disability in bathing can act as a warning for further disability in other activities and may therefore be a judicious time-point for intervention. The aim of this study was to determine the feasibility of conducting a Randomised Controlled Trial (RCT) of bathing adaptations, to evaluate whether they improve older adults’ perceived health status and quality of life, prevent further functional deterioration, and reduce the use of other health and social care resources. This study was conducted in preparation for a powered RCT.MethodEligibility criteria were aged > 65 and referred to local authority housing adaptations service for an accessible flush-floor shower. Participants were randomised to either usual adaptations (3–4 month wait) or immediate adaptations (no wait). Outcomes were assessed at 3, 6 and 9 months and included perceived physical and mental health status, health and social care related quality of life, independence in activities of daily living (ADL) and bathing, and falls. Data on costs and the use of health and social care resources were collected during follow-up in order to inform a definitive health economic evaluation.ResultsSixty participants were recruited and randomised, 31 to immediate adaptations and 29 to waiting list control. Mean age was 77(SD8), 58% women and 58% living alone. Follow-ups were completed with 90, 85 and 72% at 3, 6 and 9 months respectively. Adaptations were delivered to 65% of participants within the requisite timescales as there were delays with some privately owned properties. There were improvements from baseline in both groups on all outcome measures following the completion of the adaptations.ConclusionsThis is the first RCT of housing adaptations in the UK. We demonstrated the feasibility of using a waiting list control, subject to minor alterations to the timescales for privately owned properties. A powered trial would evaluate the impact on older adults’ quality of life and investigate the impact of waiting times on functional outcomes and health and care resource use.Trial registrationISRCTN14876332 Registered 12 July 2016.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6200-4) contains supplementary material, which is available to authorized users.

The lived experience of bathing adaptations in the homes of older adults and their carers (BATH‐OUT): A qualitative interview study

“…This study has highlighted a number of ways that bathing impacts, specifically both within the bathroom and more broadly, identifying a range of outcomes which are important to older adults and their carers. The findings were also consistent with the trends in improvement in the outcome measures used in the BATH‐OUT feasibility RCT (Whitehead et al, ), namely health and social care‐related quality of life, independence in daily living and reduced fear of falling. This has enabled us to draw comparisons, highlight measures for use in further practice and research, and to underpin the use of these measures with details of how these issues impact on lived experiences.…”

“…This study has highlighted a number of ways that bathing impacts, specifically both within the bathroom and more broadly, identifying a range of outcomes which are important to older adults and their carers. The findings were also consistent with the trends in improvement in the outcome measures used in the BATH-OUT feasibility RCT (Whitehead et al, 2018), namely health and social care- Overall, the difficulties were reported to stem from the physical barriers in the bathroom, the removal of which led to increased ease of use, a sense of 'freedom', and the older adults feeling better able to physically function in their environment. This finding could be framed within environmental press theory (Lawton & Nahemow, 1973) which postulates that an individual's competence in functioning is at its best when the environment is moderately challenging.…”

“…A feasibility Randomised Controlled Trial (RCT) randomised 60 older adults to an expedited bathing adaptations process compared to an approximate 4-month routine waiting list control. The results of the RCT are reported elsewhere (Whitehead et al, 2018) but showed indicative improvements in both groups following the adaptations with outcomes including perceived physical and mental health status, quality of life and fear of falling. In this qualitative study, the principal aim was to explore the lived experience of older adults and their carers who had received a bathing adaptation in order to examine how the adaptation had affected them and identify mechanisms of impact and outcomes from their perspectives within a transactive person-environment framework.…”

“…All adults, aged 65 or over, referred to the ARA by a social care occupational therapy team member for provision of an accessible showering facility between August 2016 and March 2017 were approached to take part in the BATH‐OUT study (Whitehead et al, ). An accessible shower is a flush floor anti‐slip walk in ‘level access’ facility (which may also be termed a ‘wet room’).…”

Bathing adaptations in the homes of older adults and their carers (BATH-OUT): a qualitative extended follow-up study with concurrent nested outcome assessments

“…Provision of bathing adaptions therefore may delay functional deterioration, improve health and quality of life, and postpone the need for other health and social care services. 3 We previously completed a feasibility RCT of major bathing adaptations (BATH-OUT) 10 and a concurrent qualitative interview study. 11 Sixty adults aged 65 and over, and their carers, were randomised to expedited provision of bathing adaptations versus routine waiting list control.…”