Bath aids and the subsequent development of bathing disability in community-living older persons

Evaluating the task effectiveness and user satisfaction with different operation modes of an assistive bathing robot in older adults

Bathing robots have the potential to foster the independence of older adults who require assistance with bathing. Making human-robot interaction (HRI) for older persons as easy, effective, and user-satisfying as possible is, however, a major challenge in the development of such robots. The study aimed to evaluate the effectiveness (coverage, step effectiveness) and user satisfaction (After-Scenario Questionnaire, ASQ) with three operation modes (autonomous operation, shared control, tele-manipulation) for the HRI with a bathing robot in potential users. Twenty-five older adults who require bathing assistance tested these operation modes in a water rinsing task for the upper back. Autonomous operation led to maximum effectiveness (100%), which was significantly worse in the shared control (51.6-79.4%, p ≤ 0.001) and tele-manipulation mode (43.9-64.4%, p < .001). In the user-controlled modes, effectiveness decreased with decreasing robot assistance (shared control: 51.6-79.4% vs. tele-manipulation: 43.9-64.4%, p = 0.009-0.016). User satisfaction with the autonomous operation (ASQ: 2.0 ± 1.0pt.) was higher than with the tele-manipulation mode (ASQ: 3.0 ± 1.4pt., p = 0.003) and in trend also than with the shared control mode (ASQ: 2.5 ± 1.5pt., p = 0.071). Our study suggests that for an effective and highly satisfying HRI with a bathing robot in older users, operation modes with high robot autonomy requiring a minimum of user input seem to be necessary.

Impairment in activities of daily living and readmission in older patients with heart failure: a cohort study

OBJECTIVES

This study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.

DESIGN AND SETTINGS

A prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.

RESULTS

There were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).

CONCLUSIONS

In summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.

Exploring the use of assistive products to promote functional independence in self-care activities in the bathroom

In homes, problems in daily functioning of older people often occur in the bathroom, especially in the transfers to the toilet and/or shower/bath. Assistive products have the potential to maximise functional independence (i.e. performance without assistance from another person) in everyday activities; however, more research is needed to better understand the impact of this technology on independence in the transfers in the bathroom. Additionally, little is known about the role of the environmental factors in the process of implementing bathroom adaptations. Therefore, this cross-sectional study aimed to examine the relationship between the use of assistive products and independence in the transfers in the bathroom. The secondary objective was to determine the role of the environmental factors in predicting the implementation of bathroom adaptations. 193 community-dwelling older adults with disabilities in the basic activities of daily life, who requested public long-term care services in Spain, were included. Data was collected in the participant´s homes using a standardised assessment procedure. There was no significant association between the number of categories of assistive products used in the toilet transfer and the independent performance of this task. In a multivariate model, the number of categories of assistive products used in the transfer to shower/bath was positively associated with the independent performance of this transfer (OR = 2.59, 95%CI = 1.48–4.53; p = 0.001). A multivariate analysis revealed that social functioning was significantly associated with the implementation of a bathroom adaptation; social risk was lower in participants who made an adaptation (OR = 0.76, 95%CI = 0.63–0.93; p = 0.006). Assistive products may play an important role in promoting independence in the bathroom. Assistive product needs should be addressed when planning community-based interventions aimed at improving daily life. Moreover, social functioning had a strong influence on the installation of bathroom adaptations, suggesting the importance of paying special attention to social factors in the home adaptations planning process.

The Occupation-Based Intervention of Bathing: Cases in Home Health Care

Although bathing skills can be an indicator of long term placement, documentation of occupational therapists doing bathing as an occupation-based intervention is limited. Five clients were referred to a hospital-based home health agency with various diagnoses and at different levels of functioning. Each client was assessed at admission and discharge using the Outcomes and Assessment Information Set and the occupational therapists used the Activities of daily living (ADL) of bathing as the intervention based on client centered expressed needs. Findings reveal a statistically significant change in individuals pre- and post-assessment of bathing (Z = -2.032, p = .042) supporting occupation-based interventions, specifically bathing, should be further researched as a means of significantly improving the functional status of clients.

Elderly and caregiver demand: proposal for a care need classification

OBJECTIVE

To propose a care need classification for elderly people by identifying their functional demands.

METHOD

Cross-sectional study carried out in São Paulo, in 2006, with 1,413 elderly (≥ 60 years old), participants in the Health, Well-being and Aging study (SABE - Saúde, Bem Estar e Envelhecimento). For the care need classification, we used the Guttman Scaling method e the frequency of assistance required by the elderly.

RESULTS

The hierarchy of activities of daily living had good internal consistency (α = 0.92) and satisfactory coefficients of reproducibility (98%), scalability (84%) and minimum marginal reproducibility (87%). Care need was categorized into: no need (requires no caregiver), minimum need (requires caregiver sporadically), moderate need (requires caregiver intermittently) and maximum need (requires full-time caregiver).

CONCLUSION

This classification will allow identifying elderly that need assistance in everyday activities and will orientante health professionals in the development of a line of care.

Functional disability and ability 75-year-olds: a comparison of two Swedish cohorts born 30 years apart

OBJECTIVE

to compare the level of functional disability and involvement in leisure activities between two birth cohorts of Swedish 75-year-olds examined in 1976-77 and 2005-06.

DESIGN

cohort comparison.

SETTING AND PARTICIPANTS

representative data from the general population in Gothenburg, Sweden, examined at the age of 75 in 1976-77 (n = 744), and in 2005-06 (n = 731) with comprehensive somatic and psychiatric examinations.

MEASUREMENTS

activities of daily living (ADL); instrumental activities of daily living (IADL); a battery of self-report measures, including involvement in leisure activities, satisfaction with home-environment, social networks and self-rated health.

RESULTS

functional disability in ADL decreased between the cohorts (13.9 versus 5.6%, P < 0.001). Functional disability in IADL also decreased between the cohorts (33.4 versus 13.0%, P < 0.001). Combining ADL and IADL resulted in an overall decreased dependency, with the largest decrease seen in women (42.3 versus 15.1%, P < 0.001). Involvement in leisure activities increased between the cohorts. For example, the proportion going on international and domestic holiday travels increased (6.3 versus 16.2%, P < 0.001), and the proportion who independently drove their own car also increased (10.0 versus 53.0%, P < 0.001).

CONCLUSION

later born cohorts of 75-year-olds are less dependent in ADL and more engaged in leisure activities compared with earlier cohorts. Later born cohorts of 75-year-olds are thus better equipped to maintain a non-age-related identity compared with earlier cohorts. Our findings might serve as a reason to adopt a more positive view to ageing in a world with an increasing number of older people.

Exponential increases in the prevalence of disability in the oldest old: a Canadian national survey

BACKGROUND

As most studies generally treat all 85+ year-olds as a homogeneous group, little is known about the specific disabilities of the oldest old population, those aged 90 and older.

OBJECTIVE

To estimate age-specific prevalence of disability in activities of daily living for older Canadians, including the oldest old, those aged 90 and older.

METHODS

Cross-sectional national survey with a representative sample of noninstitutionalized Canadians aged between 50 and 104 years old (n = 28,406). Disability was self-reported and defined as needing assistance to perform self-care and domestic life activities.

RESULTS

The prevalence of disability increased with age, and the rise appeared exponential when considering the oldest old. At age 90, the highest estimated rates of disability were reported for housekeeping (50%), shopping (45%) and transportation (44%), and 21% reported requiring assistance for washing themselves. Compared to the 85-89 age group, the estimated proportion of people reporting disability in the 95+ age group approximately triples for self-care activities and doubles for domestic life activities.

CONCLUSION

Even if we knew that disability increases with age, we can now state that it increases at an accelerated rate beyond age 85. Grouping people aged 85+ into one category leads to substantial underestimates of disability in the oldest old. Accurate estimates are necessary for adequate allocation of care and rehabilitation resources for a rapidly expanding age group.

Effects of a home visiting nurse intervention versus care as usual on individual activities of daily living: a secondary analysis of a randomized controlled trial

BACKGROUND

Home visiting nurses (HVNs) have long been part of home and community-based care interventions designed to meet the needs of functionally declining older adults. However, only one of the studies including HVNs that have demonstrated successful impacts on Activities of Daily Living (ADL) has reported how those interventions affected individual ADLs such as bathing, instead reporting the effect on means of various ADL indices and scales. Reporting impacts on means is insufficient since the same mean can consist of many different combinations of individual ADL impairments. The purpose of our study was to identify which individual ADLs were affected by a specific HVN intervention.

METHODS

This is a secondary analysis comparing two arms of a randomized controlled study that enrolled Medicare patients (mean age = 76.8 years; 70% female) with considerable ADL impairment. At baseline difficulty with individual ADLs ranged from a low of 16.0% with eating to a high of 78.0% with walking. Through monthly home visits, the HVN focused on empowering patients and using behavior change approaches to facilitate chronic disease self-management. Three categories of analyses were used to compare difficulty with and dependence in 6 individual ADLs between the HVN (n = 237) and care as usual (n = 262) groups (total N = 499) at 22 months after study entry: (1) unadjusted analyses that strictly depend on random assignment, (2) multinomial logistic regression analyses adjusting for baseline risk factors, and (3) multinomial regression analyses that include variables reporting post-randomization healthcare use as well as the baseline risk factors.

RESULTS

Compared to care as usual, patients receiving the HVN intervention had less difficulty performing bathing at 22 months. However, there were no effects for difficulty performing the other 5 ADLs. While no effects were found for lower levels of dependence for any ADLs, impacts were detected for the most dependent levels of 4 ADLs: patients experienced less dependence in walking and transferring, a substitution effect for toileting, and more dependence in eating.

CONCLUSIONS

Future research is needed to confirm these findings and determine how HVN interventions affect individual ADLs of older adults with multiple ADLs.

Bathing Area Safety and Lower Extremity Function in Community-Dwelling Older Adults

Occupational therapists and others frequently recommend grab bars and slip-resistant surfaces inside and outside of the bathing area to prevent accidental falls. In addition to observing and describing grab bar safety and floor surface safety, the authors tested the correlations between these safety features and three falls risk factors: lower extremity dysfunction, fear of falling, and self-reported falls history. Sixty community-dwelling participants aged at least 60 years were recruited. Only 13 of 60 (22%) in the total sample had adequate grab bars, and only 7 (12%) had adequate surfaces both inside and outside the bathing area. Of those with less than ideal scores on the Short Physical Performance Battery (SPPB) testing lower extremity function, 39 of 52 (75%) did not have adequate grab bars and 31 of 52 (60%) had inadequate surfaces inside the bathing area. The point-biserial correlation between the SPPB and grab bar adequacy was statistically significant ( r = −.41), indicating a mild tendency for grab bar adequacy in individuals with relatively low SPPB scores. However, there was little relationship between the SPPB and slip-resistant surfaces inside ( r = −.08) or outside ( r = .07) the bathing area. Secondary analyses found no discernible relationships between bathroom safety equipment and participants' self-reported histories of falls or their fear of falling. Of the five participants reporting histories of severe falls, all lacked adequate grab bars and non-slip surfaces. Modifications to improve the safety of bathing areas for community-dwelling older adults at risk for falls are needed.

Perspectives of older persons on bathing and bathing disability: a qualitative study

OBJECTIVES

To understand the bathing experiences, attitudes, and preferences of older persons in order to inform the development of effective patient-centered interventions.

DESIGN

Qualitative study using the Grounded Theory framework.

SETTING

In-depth, semistructured interviews were conducted in participants' homes.

PARTICIPANTS

Twenty-three community-living persons aged 78 and older identified from the Precipitating Events Project (PEP).

MEASUREMENTS

Open-ended questions about bathing habits, personal meaning and purpose of bathing, difficulties and concerns about bathing, preferences for independent bathing, and attitudes toward different types of bathing assistance.

RESULTS

Three themes emerged: the importance and personal significance of bathing to older persons; variability in attitudes, preferences, and sources of bathing assistance; and older persons' anticipation of and responses to bathing disability.

CONCLUSION

The bathing experiences described by study participants underscore the personal significance of bathing and the need to account for attitudes and preferences when designing bathing interventions. Quantitative disability assessments may not capture the bathing modifications made by older persons in anticipation of disability and may result in missed opportunities for early intervention. Findings from this study can be used to inform the development of targeted, patient-centered interventions that can subsequently be tested in clinical trials.

Criterion validity of a home health aide's algorithm for recommending bathroom equipment

Background

Occupational therapists are experts at adapting bathroom environments. However, to increase access to services, the algorithm “Préalables aux soins d'hygiène” (French for “Prerequisites for bathing care”) has been developed to be used by trained home health aides to recommend bathroom equipment.

Purpose

The purpose of this study was to assess the criterion validity of the algorithm by measuring the level of agreement between an occupational therapist's recommendations (gold standard) and those made by four home health aides using the algorithm.

Methods

Community-living adults with bathing difficulties (n = 96) were visited by both types of evaluators.

Findings

Home health aides correctly identified clinical situations in which they should feel confident about their ability (sensitivity: 96%, specificity: 69%) and, apart from type of bathing seat (Kw = 0.63 [0.52; 0.75]), agreement between recommendations varied from substantial to almost perfect (△≥0.72).

Implications

Results increase confidencein the algorithm, but other studies are needed to ensure population safety and fulfil the occupational therapist's obligations.

Psychometric properties of a scale to assess the severity of bathing disability

OBJECTIVE

To develop and evaluate the psychometric properties of a new bathing disability scale.

DESIGN

Reliability and validity study.

SETTING

General community.

PARTICIPANTS

Two subsets of community-living older persons, selected from an ongoing longitudinal study, who had some degree of bathing disability or were at increased risk for bathing disability, as determined during a comprehensive assessment at 36 (N=199) and 54 (N=213) months, respectively.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The bathing disability scale was administered at 36, 54, and 72 months, and changes in scores were assessed between 36 and 54 months and 54 and 72 months, respectively, for the 2 subsets of participants. Convergent construct validity was evaluated by comparisons with changes in activity of daily living (ADL) disability, mobility disability, and the Short Physical Performance Battery (SPPB). Discriminative construct validity was determined by comparisons according to age and physical frailty. Responsiveness was evaluated by comparisons between participants who had and had not been hospitalized and, subsequently, by plotting correlations according to the timing of these hospitalizations.

RESULTS

The test-retest reliability was high, with an intraclass correlation coefficient=0.76 (95% confidence interval=0.59-0.94). The internal consistency reliability was excellent with Cronbach alpha=0.91-0.97. Changes in scores on the bathing disability scale were positively correlated with changes in scores in ADL and mobility disability and inversely correlated with changes in scores on the SPPB. A greater decline in scores was observed among the oldest old and those who were physically frail, but these differences did not consistently achieve statistical significance. The scale was responsive to the occurrence and/or timing of intervening hospitalizations.

CONCLUSIONS

The bathing disability scale is reliable, valid, and responsive and may be suitable for use in clinical trials to evaluate the effectiveness of interventions to enhance independent bathing.

Assistive technologies in the home

Assistive technologies are critical to elders maintaining independence in the home. Adequate assessment of the patient's needs, the appropriateness of the device to that need, and the patient's motivation to use of a device is required for successful outcomes. A team approach is needed to ensure that devices are correctly prescribed, and the patient is taught how to use it effectively. A wide range of devices is available to support activities of daily living, mobility, home management, and safety. The use of personal computers is significantly expanding the possibility of independent living through support systems, monitoring systems, and information resources.