The Center For Health Design
Why does this study matter?
People living with dementia have reduced coping thresholds that frequently result in maladaptive behavioral responses and bathing is a common source for patient stress as well as caregiver burden. While previous studies generally support the use of multisensory environments (MSE) to improve the patient experience, the feasibility of using MSE during bathing to improve patient and workforce outcomes has not been studied.
This study was undertaken within the Veterans Health Administration to understand the behavioral effects of multi-sensory stimulus during bathing for Veterans with dementia.
How was the study done?
The researchers conducted a controlled clinical trail in 2018 designed to assess the impact of a multisensory behavioral intervention during assisted bathing to improve the patient experience. The study took place in a 187 bed major US military LTC facility in the southeast US. The setting consisted of a single open-plan communal bathing room with gray ceramic tile walls and floor, a solid surface ceiling, and fluorescent lighting. The participant sample consisted of a convenience sample of four veterans with advanced dementia. For consistency, 1 Nurse and 4 Certified Nursing Assistants provided bathing and administered the intervention in teams of 2 over a period of two months. The intervention consisted of MSE equipment, including: A bathing chair, solar wall projector, preferred music, lavender aroma therapy for men, peppermint aroma therapy for women, and color changing wall washer lights, a bubble tube, and handheld waterproof fiber optic cables. The study used a single-case research design with staggered starts so each participant could serve as their own A-to-B control. Bathing was offered twice per week and each video-recorded session served as the unit of measurement.
What do we learn from the study?
A total of 48 bathing session video recordings were reviewed by two study team members to reduce bias and maintain interobserver agreement. Behaviors were coded and classified as either positive or challenging in accordance with the Care Assessment Bathing Tool developed by Sloane and colleagues. Two of the 4 participants displayed an increase in positive behaviors including, emotional happiness and engagement, between baseline and the intervention. All 4 of the participants demonstrated a decrease in distressed behaviors, including physical or verbal aggression, agitation, sadness, anger and anxiousness, between baseline and the intervention. The increase in positive behaviors and decrease in negative behaviors supports a functional relationship between improved bathing responses and multisensory interventions.
Can we say the results are definitive?
As with any study that has a small sample size, it can be difficult to make broad generalizations. Further, it is possible that positive or negative behavioral reactions could be credited to isolated MSE stimulus or the individuals who provided bathing assistance. Future studies would benefit from a larger, more diverse sample as well as evaluating the interior design features (e.g., lighting, finishes, fixtures, etc.) and layout of the bathing room in addition to multisensory equipment.
This study took place in a bathing room that is representative of most found in long-term care settings. While it might not make sense to include every possible type of sensory stimulus in every bathing environment, intuitive and adaptive solutions that can be modified to suit the sensory preferences of patients should be considered. Multidisciplinary groups of designers, care providers, and patient advocates should come together during the design planning process to consider which types of passive and active sensory elements may benefit patients and caregivers during bathing.
What’s the takeaway?
While there is general support for using multisensory environments (MSE) as a therapeutic tool for improving patient outcomes, the feasibility of using MSE during bathing has not been studied. This study was undertaken in a bathing room that is representative of most found in long-term care settings within the Veterans Health Administration to understand the behavioral effects of MSE stimulus during bathing for Veterans with dementia. In general, the increase in positive behaviors and decrease in negative behaviors exhibited within this study supports a functional relationship between improved bathing responses and multisensory interventions.
Summary of:
Lorusso, L., Bosch, S., Park, N.-K., Shorr, R., Conroy, M., Ahrentzen, S., & Freytes, M. (2022). Investigating the feasibility of multisensory environments to improve the assisted bathing experience for veterans with dementia: A clinical trial. HERD: Health Environments Research & Design Journal, 15(2), 180–195. https://doi.org/10.1177/19375867211053861
Our slidecasts are an outcome of the popular Research Matters presentations at the annual Healthcare Design Expo & Conference. Our research team picks papers that have some significance to the healthcare design community and distill the study down into a 5-minute summary of how the study was done, what was learned, the limitations and the takeaway. The slidecasts bring research to you in digestible format. Just five minutes, and you’ll know more.
Dr. Abushousheh is an Organizational and Environmental Gerontologist and Researcher Associate for The Center for Health Design. With combined expertise in architecture, organizational development, gerontology and applied research, Addie advances comprehensive and translational agendas related to quality assessment and performance improvement for aging and dementia in the continuum of care. In addition to publishing and presenting, Addie is a tri-chair of the Facility Guidelines Institute’s residential document group, maintains an adjunct faculty appointment at Kent State University, is a member of the Moving Forward Coalition, is a Board Member for IDEAS Institute, and serves as an Advisor to Abacus Institute and The AIA’s Design for Aging Knowledge Community.