1. @whitehead_pj @bath_out
BATH-OUT RESULTS
Bathing Adaptations in the Homes of Older Adults (BATH-OUT): Results of a feasibility Randomised Controlled Trial (RCT)
Phillip Whitehead

2. This presentation is independent research supported by the National Institute for Health Research School for Social Care Research. The views expressed in this presentation are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care

3. Good evidence minor adaptations
Study Overview
Do bathing adaptations improve older adults’ QoL and functional ability?
Do they lead to reductions in use of other health and social care services?
Do waiting times lead to poorer outcomes and increased costs?
Housing Adaptations – ‘Top Ten’ prevention for older adults (Allen & Glasby 2012)
Good evidence minor adaptations
(Powell et al. 2017)
Further research needed –UK RCTs major housing adaptations (Powell et al. 2017)

4. Bathing and Older Adults
Older Adults more likely to develop a disability in other daily activities following the onset of bathing disability
(Gill et al. 2006a)
Bathing disability also acts as a warning point for nursing home admission
(Gill et al. 2006b)
Systematic review identified only one interventional study focussing on bathing for older adults
(Golding-Day et al. 2017)

5. Method

6. Assess for Eligibility Approach for Consent
9 Month Follow up
Service User and Carer
Assess for Eligibility
Approach for Consent
CONSENT/Consultee
Baseline Assessment
Randomisation
INTERVENTION
without waiting list
3 Month Follow up
6 Month Follow up
CONTROL
waiting list (usual care)
Adaptations
(usual care)
Not Eligible or No Consent –
treatment as usual
(without waiting list)

7. Feasibility Objectives
Whether the eligibility criteria are realistic
Whether users and carers are willing to be randomised
The study attrition rate
Whether the adaptations can be completed within 4–6 weeks of allocation to a project officer
The suitability and sensitivity of outcome measures for use in the main study
The feasibility of collecting the data on costs and health and social care resource use

8. Results

9. Recruitment

10. Participant Flow & Attrition
Eligible
n=75
ARA unable to contact (n=3)
Contacted
n=72
Did not consent to UoN contact (n=6)
Unable to contact by UoN (n=1)
Unable to identify Consultee (n=2)
Arranged LAS themselves (n=2)
Referral withdrawn (n=1)
Number Participant’s Consented & Randomised (60)
(83)% of those eligible
(100)% of those visited
Immediate
n = 31
Waiting List
n = 29
Deceased (0)
Withdrew (0)
Lost to follow-up (3)
Deceased (0)
Withdrew (2)
Lost to follow-up (1)
3 Month Follow-up = 28
3 Month Follow-up = 26
Deceased (2)
Withdrew (0)
Lost to follow-up (1)
Deceased (0)
Withdrew (0)
Lost to follow-up (0)
6 Month Follow-up = 25
6 Month Follow-up = 26
Deceased (2)
Withdrew (3)
Lost to follow-up (0)
Deceased (0)
Withdrew (2)
Lost to follow-up (1)
9 Month Follow-up = 20
9 Month Follow-up = 23

11. Baseline Characteristics
Immediate Adaptations
(n=31)
Waiting List Control
(n =29)
Property Tenure
Public Sector
Owner Occupied
Housing Association
17 (55%)
9 (29%)
5 (16%)
16 (55%)
9 (31%)
4 (14%)
Age
77.74 (7.64)
76.34 (7.65)
Gender
Male
Female
15 (48%)
16 (52%)
10 (34%)
19 (66%)
Marital Status
Single
Married
Widowed
Divorced
Cohabiting
2 (6%)
8 (26%)
13 (42%)
7 (23%)
1 (3%)
5 (17%)
7 (24%)
6 (21%)
2 (7%)
Living Arrangement
Alone
With other(s)
19 (61%)
12 (39%)
13 (45%)
Ethnicity
White British
Other
25 (81%)
6 (19%)
25 (86%)
Employment
Retired
31 (100%)
29 (100%)
Carer
Within household
External to household
No carer
11 (36%)
10 (32%)
9 (32%)
Carer assists with
Domestic ADL only
Both personal and Domestic ADL
9 (43%)
12 (57%)
9 (47%)
10 (53%)
Primary Diagnosis
Muscolo-skeletal
Neurological
Respiratory
Frailty
Mental Health
3 (10%)
0 (0%)

12. Feasibility Outcome – Delivery of Intervention
Immediate Adaptations
Waiting List Control
Time from Randomisation to Completion (months) 2
(1.47)
5.6
(1.64)
Time from Randomisation to Completion (days)
48.35
(14.57)
154.57
(17.75)
Shower installed at 3 Month Follow-Up
18 (64%)
0 (100%)
Shower installed at 6 Month Follow-Up
22 (88%)
17 (65%)
Shower installed at 9 Month Follow-Up
19 (95%)
20 (86%)
No housing association properties completed within timescale
Excluding HA overall figure is 78% within timescale and 85% excluding HA plus cancelled referrals

13. Results – Suitability and Sensitivity of Outcome Measures

14. SF-36 Physical Component Summary Physical Health/Wellbeing

15. SF-36 Mental Component Summary Mental Health/Wellbeing

16. Adult Social Care Outcomes Toolkit (ASCOT) Social Care Related Quality of Life

17. EQ-5D-5L Health Related Quality of Life

18. Bathing Scale (0-100) Perceived Ease of Bathing

19. Barthel Index (Bathing Question) Independence in Bathing

20. Short-Falls Efficacy Scale Fear of Falling

21. Feasibility Outcome – Collection of Falls Data
Immediate Adaptations
Waiting List Control
Participants reporting one or more fall
Median (IQR) Falls
Total Falls
Participants Reporting one or more fall
Median (IQR)
Falls
Baseline 18
2 (1-3) 46 16
131* 3M 8
1 (1-1.5) 11 9
2 (1-10)
121* 6M 7
1 (1-2) 10 12
1.5 (1-3)
109* 9M 6
1.5 (1-2) 5 15
*One participant reported falling every day during follow-up (n=90). The participant was not followed-up at 9 months

22. Costs & Resource Use £4,878.46 average cost
Able to collect data on health and social care contacts
Personal care – paid and unpaid carers
Particular reduction in assistance from unpaid carers

23. Discussion & Conclusion

24. Summary Target Feasible? Eligibility
Identify sufficient participants to recruit 40 to 60 participants
Randomisation
Identify 40 to 60 participants willing to be randomised
Attrition
Follow up a minimum of 70% of participants at 6 months
Adaptations
Provide a minimum of 70% of adaptations within the specified timescales (both groups)
Suitability and Sensitivity of Measures
Collect a complete set of outcome data which is responsive to change
Health Economics
Collect a complete set of cost, resource use and QoL data to inform a definitive health economic evaluation

25. Conclusion A powered RCT is feasible
BATH-OUT-2
Minor change in trial design needed
Links between home and health – important public health and policy implications
Waiting times – important preventative implications
BATH-OUT-3

26. Team BATH-OUT
Stuart Belshaw, Public and Patient Involvement Representative
Tony Dawson, Manager, Adaptations and Renewals Agency, Nottingham City Council
Miriam Golding-Day, Research Assistant, University of Nottingham
Marilyn James, Professor of Health Economics, University of Nottingham
Marion Walker, Professor of Stroke Rehabilitation and Associate Pro-Vice Chancellor (Equality & Diversity), University of Nottingham

27. References
Allen, K. and Glasby, J., ‘The Billion Dollar Question’: Embedding Prevention in Older People's Services—Ten ‘High-Impact’ Changes. British Journal of Social Work, 43(5), pp
Powell, J., Mackintosh, S., Bird, E., Ige, J., Garrett, H. and Roys, M., The role of home adaptations in improving later life. London: Centre for Ageing Better.
Gill, T.M., Guo, Z. and Allore, H.G., The epidemiology of bathing disability in older persons. Journal of the American Geriatrics Society, 54(10), pp
Gill, T.M., Allore, H.G. and Han, L., Bathing disability and the risk of long-term admission to a nursing home. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(8), pp
Golding-Day, M., Whitehead, P., Radford, K. and Walker, M., Interventions to reduce dependency in bathing in community dwelling older adults: a systematic review. Systematic reviews, 6(1), p.198.
Whitehead, P.J., James, M., Belshaw, S., Dawson, T., Day, M.R. and Walker, M.F., Bathing adaptations in the homes of older adults (BATH-OUT): protocol for a feasibility randomised controlled trial (RCT). BMJ open, 6(10), p.e