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Clinical Trial
. 2004 Nov;52(11):1795-804.
doi: 10.1111/j.1532-5415.2004.52501.x.

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

Philip D Sloane  1 , Beverly Hoeffer, C Madeline Mitchell, Darlene A McKenzie, Ann Louise Barrick, Joanne Rader, Barbara J Stewart, Karen Amann Talerico, Joyce H Rasin, Richard C Zink, Gary G Koch
Affiliations
Clinical Trial

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

Philip D Sloane et al. J Am Geriatr Soc. 2004 Nov.

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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Comment in

  • The bath! Reassessing a familiar elixir in old age.
    Evans LK. Evans LK. J Am Geriatr Soc. 2004 Nov;52(11):1957-8. doi: 10.1111/j.1532-5415.2004.52527.x. J Am Geriatr Soc. 2004. PMID: 15507080 No abstract available.
  • A warm bath.
    Clarfield AM. Clarfield AM. J Am Geriatr Soc. 2005 Jun;53(6):1075-6. doi: 10.1111/j.1532-5415.2005.53338_3.x. J Am Geriatr Soc. 2005. PMID: 15935042 No abstract available.

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