Bath Transfers in Older Adult Congregate Housing Residents: Assessing the Person–Environment Interaction

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To examine environmental feature utilization (EFU) and the types and prevalence of performance difficulties during a videotaped bath transfer and to determine the personal characteristics associated with total EFU and performance difficulties.


Cross-sectional analysis.


Two congregate housing facilities in southeastern Michigan.


Eighty-nine older adults who reported independence in bathing.


Trained video coders recorded EFU (defined as upper extremity contact with features in the environment) and rated performance difficulties (defined as lack of fluid movement or difficulty negotiating the environment). EFU was measured by determining whether features used were safe (i.e., designed for use as a transfer support) or unsafe and by total EFU (i.e., number of environmental features used during the transfer). Personal characteristics included self-reported medical conditions, bath transfer difficulty, functional mobility, lower extremity strength, range of motion functional impairment, and falls efficacy.


For participants with a tub-shower, safe EFU was higher than unsafe EFU (85% vs 19%; P<.001). Participants with shower stalls had the same rate of safe and unsafe EFU (71%). In multiple regression analysis, self-reported bath transfer difficulty was associated with total EFU (P = .01). One-third of the sample had performance difficulties. In multivariate analysis, range of motion functional impairment (odds ratio (OR) = 13.49, 95% confidence interval (CI) = 1.11–163.53) and lowest quartile in falls efficacy scores (OR = 5.81, 95% CI = 1.24–27.41) were associated with performance difficulties.


Unsafe EFU and performance difficulties were common in independently bathing older adults. Self-reported bath transfer difficulty appears to be a good indicator of high total EFU and may be used as a screening question for clinicians. Important strategies to reduce unsafe EFU and to increase falls efficacy include removing shower sliding glass doors and training older adults in safe transfer techniques.

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