Beginning a discussion about good bathing practices helps ensure that new technological developments provide the necessary assistance seniors require to remain self-sufficient or regain independence. As the largest organ in the body, the skin preforms regulatory functions including temperature maintenance, expulsion of toxins through sweat and prevention of dehydration, and skin is part of the body’s defense system against infection. Thus, skin maintenance becomes even more critical as we age. The fragile state of skin in many individuals who face bathing disabilities compounds the necessity to be sure we are actively cleaning and taking care of the skin while also protecting and enhancing its integrity. Removing dead skin cells and body waste from the skin’s surface is important to our health but ironically, many of the activities we undertake (soaps, warm water, astringents) remove protective oils and decrease the inherent protective nature of skin.
The cost of wound management for fragile skin becomes significant because wounds are a primary source of allowing infection into the body, which can have a significant impact on the quality of daily life. Ensuring bathing routines and rituals promote healthy skin requires an individualized approach to bathing to account for the needs of the skin as well as our social needs. Hygiene is an issue that can be particularly difficult to discuss with the people we are closest with. However, hygiene issues can contribute significantly to the cost of health care, long-term care and the ability to stay independent. It remains unclear exactly what causes urinary tract infections (UTI), particularly in the elderly, and a wide variety of organisms are responsible. However, 70 percent of UTIs in non-catheterized patients are caused by E. coli. In patients with a catheter, E. coli is responsible for roughly 40 percent of UTI diagnoses. Attention to hygiene can significantly reduce the impact of E. coli transfer and colonization. Meticulous personal hygiene and appropriate incontinent care are crucial in the elimination of reinfection UTIs. In a study of non-catheterized, elderly, long term care residents, results showed a significant reduction in UTI risk factors when correct hygiene protocols were followed by caregivers. As we age, we face more difficulty with the activities of daily living. Bathing disability is one of those critical activities that can take away independence. Bathing disability is defined as the inability to wash and dry one’s whole body without personal assistance. A number of studies and personal experiences tell us that when a person experiences bathing disability, it is associated with long-term nursing home admission. The strong relationship between bathing disability and nursing home admission exists even when there are other disabilities impacting daily activities. When studied in adults age 70 and older, the onset of a bathing disability increased the likelihood of developing a disability in the other activities in the following month by five times. It’s important to note that a bathing disability can be a transient disability. In a 2006 study, researchers found that approximately one-third of the participants had multiple episodes of bathing disability, with the duration of each episode averaging about six months. Bathing disability is not commonly proceeded by other disabilities, and it strongly predicts subsequent disabilities, so the ability to prevent the onset of bathing disability becomes critical to being able to age in place. Technological developments in the bathing environment in the form of chairs, benches, mats, grab bars, hand held showers, etc. are personal. The ADA provides us with guidelines about how to make environments accessible, but the ADA doesn’t account for the specific disabilities of a person and the type of assistance they need. Technology doesn't have to mean a device with a screen, wires or electricity. Technology is defined as the application of scientific knowledge for practical purposes. The goal is to understand, and apply what we understand, to the problems that need solving. More specifically, assistive technology refers to any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. In a series of interviews in Connecticut in 2010 with adults age 70 and older living at home, researchers found most pieces of assistive technology in use in bathrooms were not selected because of the resident’s specific bathing disability, but because the resident had seen an advertisement for the piece of technology. The sources for information did not include a professional needs assessment at all. We need to take a critical eye to bathing. Talk about the problems that exist. Ask how you can help solve those problems. Talk about hygiene. Discuss how your loved one is currently bathing. Will a grab bar or tub-cut really address the bathing disability your loved one is experiencing? Does a handheld shower head really allow the bather to address all their hygiene needs? Or is a bidet or seated shower more appropriate? There are a plethora of options to address bathing disabilities today. Take time to address the benefits of bathing and find an appropriate piece of bathing technology for your loved one.