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Effect of Person-Centered Showering and the Towel Bath on Bathing-Associated Aggression, Agitation, and Discomfort in Nursing Home Residents with Dementia: A Randomized, Controlled Trial

Authors

  • Philip D. Sloane MD, MPH,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Beverly Hoeffer DNSc, RN,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • C. Madeline Mitchell MURP,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Darlene A. McKenzie PhD, RN,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Ann Louise Barrick PhD,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Joanne Rader MN, RN,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Barbara J. Stewart PhD,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Karen Amann Talerico PhD, RN,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Joyce H. Rasin PhD, RN,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Richard C. Zink MS,

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • Gary G. Koch PhD

    1. From the *Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, Department of Psychology, §School of Nursing, and Department of Biostatistics, University of North Carolina, Chapel Hill, North CarolinaSchool of Nursing, Oregon Health and Science University, Portland, Oregon.
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  • The study, Clinical Trial of Two Bathing Interventions in Dementia, was funded by Grant R01-NR-04188 from the National Institute for Nursing Research. Preliminary and pilot work was funded by Grants RO1-AG11506 and R01-AG11504 from the National Institute on Aging. Portions of this paper were presented at the annual meeting of the Gerontological Society of America, Washington, DC, November 2000.

Philip D. Sloane, MD, MPH, Cecil G. Sheps Center for Health Services Research, 101 Conner Drive, Suite 302, University of North Carolina, Chapel Hill, NC 27599. E-mail: psloane@med.unc.edu

Abstract

Objectives: To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap).

Design: A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover.

Setting: Nine skilled nursing facilities in Oregon and six in North Carolina.

Participants: Seventy-three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them.

Measurements: Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora.

Results: All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person-centered shower group (P<.001) and 60% in the towel-bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person-centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans.

Conclusion: Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia.

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