The best evidence for assisted bathing of older people with dementia: a comprehensive systematic review

Abstract

Background Agitated behaviours related to dementia are commonly found in aged care. These behaviours are the major cause of stress and burden for caregivers and often result in institutionalisation of family members with dementia. Despite the high prevalence and the very real impact that agitated behaviours have on caregivers’ psychological and physical well-being, to date no systematic reviews have been published concerning the best management approach for agitated behaviours during assisted bathing for older adults experiencing dementia. Objectives The objective of this systematic review was to examine the best available evidence concerning how to minimise agitated behaviours in older adults with dementia being assisted with bathing. Inclusion criteria Types of participants Studies of older adults with dementia requiring assisted bathing from nurses, formal care staff or family caregivers were considered for inclusion in this systematic review. Types of intervention(s)/phenomena of interest The quantitative component considered interventions aiming to minimise agitated/aggressive behaviours during assisted bathing. The qualitative component considered phenomena related to assisted bathing of older adults with dementia and the textual component considered supplemental evidence to both components. Types of studies The quantitative component included experimental and quasi-experimental studies while the qualitative component considered any qualitative study methodology. Types of outcomes The outcome measures in the quantitative component included frequency and severity of agitated/aggressive behaviours. Search strategy The search aimed to identify both published and unpublished studies from 1990 to April 2011. Only papers published in the English language were included. The searched major databases were MEDLINE, CINHAL, EMBASE, Cochrane Library of Systematic Review, JBI Library of Systematic Reviews. The grey literature search was conducted using Conference Proceedings, Dissertation International, TRIP, Mednar, Google Scholar, Google and websites of professional bodies in the aged care field. A standardised three-step search strategy was used. Methodological quality Methodological quality of included papers was assessed by two independent reviewers. Standardised critical appraisal tools from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information were utilised. Methodological quality of included quantitative studies ranged from moderate to poor and the qualitative studies ranged from moderate to high quality. The textual papers were generally of high quality. Data collection Standardised data extraction tools derived from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information were utilised. Data synthesis Due to the existence of clinical and methodological heterogeneity, the quantitative data were synthesised using a narrative approach. The qualitative data and textual data were synthesised using appropriate software from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Results The review included five quantitative studies, two qualitative studies and eight textual opinion papers. The identified quantitative evidence supports using the person-centred showering approach, towel bath/thermal bath and preferred music of older adults. The qualitative evidence emphasised concepts including safety and retaining a sense of dignity and control of patients, and relevant assessment skills of caregivers. The textual evidence addressed the shift from custodial discourse to a creative and therapeutic person-centred approach, and a safe and private bathing environment. Conclusions All quantitative, qualitative and textual evidence encouraged the introduction of a person-centred showering approach for assisting the bathing of older adults with dementia.