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

Abstract

The onset of disability in bathing may be followed by disability in other daily activities for older adults. A bathing adaptation usually involves the removal of a bath or inaccessible shower and replacement with a level, easy access shower. The purpose is to remove the physical environmental barriers and restore older adults’ ability to bathe safely and/or independently. The aim of this study was to explore the views and experiences 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. The study was nested within a feasibility Randomised Controlled Trial (RCT) (BATH‐OUT) conducted within one local authority housing adaptations service in England. Semi‐structured interviews were completed between 21 December 2016 and 19 August 2017 with 21 older adults and five carer participants of the feasibility RCT. Interview participants were purposively sampled on living arrangement and gender. Interviews were audio‐recorded, transcribed verbatim and analysed in seven stages using framework analysis. Findings were presented thematically. Five themes were identified: ease of use; feeling safe; feeling clean; independence, choice and control; and confidence and quality of life. The removal of the physical barriers in the bathroom led to older adults re‐mastering the activity of bathing, having an improved sense of physical functioning which gave a sense of ‘freedom’. This appeared to impact a range of areas contributing to a wider sense of increased confidence consistent with constructs underpinning social care‐related quality of life. We suggest that future research should examine housing adaptations from a person–environment fit approach, and that timely restoration of bathing ability is especially important as it can affect confidence and perceived competence in other areas of daily living.

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

“…Choice and control relates to the older adults' autonomy to carry out their bathing routine at the time and frequency of their choosing. Several of the older adults reflected on how the adaptation had enabled them to continue to bathe as they would like (quotation #6), though it did appear to be less related to bathing independently as found in the previous BATH-OUT analysis, 11 and had become part of their routine and habit now that they had become accustomed to carrying out the activity on their own volition. This theme was closely linked with having help from another person in the bathroom and the older adults' feelings about having that help (quotation #7).…”

“…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. Indicative findings showed improvements from baseline in both groups on all outcome measures following the installation of the accessible shower.…”

“…The findings were that the removal of physical barriers in the bathroom led to an improved sense of physical functioning which also impacted on the older adults’ wider sense of confidence. The BATH-OUT qualitative findings 11 were located within a framework of a moderated social model of disability, 12 person-environment fit 13 and environmental press theory 14 postulating that people are disabled by barriers within their environment and that the environment needs to be optimally ‘challenging’ for the person in order to maintain optimum function.…”

“…The primary objective of this study was to revisit participants from the BATH-OUT qualitative interview study at 18–28 months on from the completion of their bathing adaptation in order to explore their lived experiences at this later time point. Ease of use had been highlighted as a key theme in the original BATH-OUT interview study, 11 so we aimed to investigate whether usability and the other lived experiences reported in the original interview study were still evident in participants’ narratives 2 years later. A secondary objective was to collect the outcome measures used in the feasibility RCT at this later time point.…”

Reflections on Cross-Cultural Comparison of the Impact of Housing Modification/Adaptation* for Supporting Older People at Home: A Discussion

“…The impact of housing modification: Discussion longitudinal research, such as that by Whitehead and Golding-Day (2019), which built on the RCT of bathroom adaptations (Whitehead et al, 2018).…”