Walkin Bath Tub and Walkin bath Tubs

Current Design Has Remained Unchanged For Many Years

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. My Mother’s bathtub, your bathtub, is much like the Minoan tub, the only difference being ours are made of manmade materials and have flowing hot and cold water. Showers are relatively new. In fact, the earliest showers were actually developed for medicinal purposes (e.g. water cure or rain bath) in the early 1800s. Showers only became common with the introduction of indoor plumbing. But, the design of home showers in America 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First, these products are outdated and they fail to meet the physical needs of the aging population.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” solutions to complex problems not satisfied by conventional showers and tubs. For example, the “clamp-on” assistance bar installed by my Mother to the outside wall of her tub seemed like a good idea, in theory, but in practice contributed to her death when it moved just enough to set her fall in motion. These devices highlight failures in conventional design and unresolved problems. Grab bars make up somewhat 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 in their exact location, but are potentially dangerous. They reflect the need for safer footing. Bath seats are a reminder of people’s inability to stand or lower themselves into a tub while bathing. They point to the need for alternative ways of bathing and improved technology.

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 and those with disabilities. For example, the positioning of controls and accessories often requires standing, bending, gripping and a wide range of motion. Bathtubs and showers require good balance, flexibility and strength when both using them, and when transferring in and out of them.

Third, the design of bathtub/showers does not reflect a lifespan perspective. Conceptually, as children, we begin to bathe on our own by the time we are 6 to 7 years old. We continue to do so as grownups until we are about 50-60 years old. Beyond this age, we 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 age-related changes. For example, when unable to stand and bathe, people sit down while bathing. This often takes the form of unstable and dangerous stools, benches, even plastic patio chairs, being placed in bathtubs or showers. 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.

My research and Study

The Purpose

My investigation and research was conducted to assess the bathing needs and preferences of older persons living at home; in particular,… my Father. I wanted to generate qualitative data on bathing, and I aimed at understanding a variety of bathing issues. The question is,… how do we design an in-home bathing facility capable of providing greater safety and access to all? How do we provide ourselves, and loved ones, with the ability to live independently, and bathe with dignity and safety in our own homes for as long as possible?

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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 agents 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 and the mobility difficulties affecting the greatest number of elderly was 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.

Why Is This Happening?

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 to reach 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 water 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. So, there are many factors that can injure, independently, or contribute to or lead to fall related injuries.

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The Magnitude of the Problem

Accidental Deaths

I, and other 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 indicated that as many as 70 persons over the age of 65 die of bathtub-related burn injuries every year in the US alone. That is nearly 6 people dying each month from hot water scalding!  According to the National Safety Council, one person dies everyday from simply using the 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. The numbers are sure to increase rapidly with the transition of the parents of Baby Boomers and, thereafter the huge Baby Boomer generation, into elderhood. Bathtub related deaths during the three-year period from 1987-1989 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 the years 1979-1981. They concluded that those over the age of 75 accounted for the most 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. 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 in the American 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 bathroom. About 30 percent of all home accidents are due to falls, the sixth leading cause of death. Falls result in 200,000 hip fractures, 25 percent of all hospital admissions for people over 65, and as much as 80 percent of all nursing home admissions are, directly or indirectly, due to fall related injuries and recovery.

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Bathing is vital to our wellbeing. 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 a bath, bathing is more difficult, more time consuming and more hazardous for older people, especially for older people with disabilities. Most of the data available to me is nearly twenty years old, and in need of updating to take into account the rapidly aging Baby Boomer generation, that will most certainly increase numbers. However, my personal interviews with hundreds of seniors over the past year indicate that the issues are still the same, even though potentially greater in severity.

In the 1980s, the Gallup organization surveyed 1,500 non-institutionalized people over the age of 55. “Using the shower or tub” was one of the major problem areas identified by them for maintaining activities of daily living. The magnitude of problems older people experience while bathing and the seriousness of their situations, raise 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 next to Godliness.” People’s obsession to maintain a clean body is well known. Americans take, on average, at least seven baths a week. Since the 1960s, 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).

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Many family care-providers experience very high levels of mental stress from providing care to their relatives. They use walkin bath tub, and walkin bathtubs. Emotional stress is the most difficult part of being a family care-provider, who sometimes are themselves older and have other family responsibilities. In addition to looking after other family members, many work outside their homes as well. Consequently, they feel pressured to meet their obligations. Most of them are exhausted from providing constant attention and are burdened from having to contend continually with family care. Often, lack of acknowledgment from the one receiving care greatly escalates the level of emotional stress.

Client-related stress varies with:   Walkin bath tub and walkin bath tubs
• size, shape and physical condition of the client, and •the level of nervousness, cooperation, and willingness the client may display during bathing.
Environment-related stress is dependent on:
• the availability of transferring devices, and
• physical features of the bathroom such as the tub height, presence of sliding glass doors, bathroom layout, narrow width of clearances, floor conditions and low lighting level.
Care-provider related stress is a function of height, weight and physical condition of the care-provider, and the time pressure resulting from trying to complete all tasks quickly.
Conclusion

Safe and accessible bathing is not solely a concern of the elderly, disabled and those caring for them. It is of utmost importance to all people irrespective of their age, sex and cultural background. Eliminating accidental deaths and injuries is of prime importance in creating a safe bathing environment. To provide greater stimulation, control and personal empowerment for bathers and care-providers, the following design principles should be observed when making modifications to existing bathrooms and the design of the future bathing equipment. It is important that individuals consult their therapist and evaluate their needs before making modifications or purchasing devices.

1. Enhance Security
Bathing safely and with comfort is largely an environmental issue and is guided by the quality and physical characteristics of the environment. As we know, the incidence of falling while bathing threatens all persons regardless of age but specially those with poor balance. In addition, falling while providing care threatens the safety and well being of care-providers.
Recommendations for Existing Bathrooms:
•Emergency Rescue Devices

Install emergency devices such as telephones or intercoms within effortless reach of the users. These devices provide greater personal security. They can alert monitoring individuals about accidents, advise accident victims about how to get out of a crisis, and help individuals in the rescue operation.

•Better Illumination
Low illumination together with poor vision makes it difficult to detect articles scattered around. Better illumination will direct attention to potential threats from protruding objects and other hazardous conditions. This can be achieved through:
•additional light sources in the bath area, •natural daylight via appropriate size window,
•light colored walls in the bathroom, and •using a transparent curtain.
• Storage

Accessories lying around create hazardous bathing conditions. Provide greater storage space through wall-mounted shelves. This will prevent accidents from bumping objects into and skidding from articles scattered around the floor.

Recommendations for New Bathing Equipment:
•incorporate easy to use rescue device and locate them in a strategic position
•consider smart devices that will alert the central monitoring system at the time of an   emergency •build-in lighting fixtures into the design of the equipment
•allow for adjusting the illumination level
•offer a choice of direct or diffused lighting
•build-in storage into the design of the equipment
•enable individuals to alter the location and size of storage
•round all edges and soften all corners to reduce the chances of injury in a fall
•give a safe appearance to the surroundings through recessed fixtures and rounded  edges

•install anti-scalding device

2. Making Safe Transfers

Getting in and out of the tub is the most critical aspect of bathing independently. It is also the most difficult aspect of providing care. Poor balance and fear of falling greatly affects people’s ability to make safe transfers. Awkward tub shape, inadequate maneuvering space and slippery floor conditions greatly adds to problem.

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