Among community-living older persons, disability in bathing (i.e. washing and drying one's whole body) is highly prevalent, is a strong predictor of morbidity and mortality, and is a primary indication for home aide services. Yet, the evidence base to help guide the prevention and remediation of bathing disability is relatively scant. The long-term objective of this research is to rigorously evaluate targeted and clinically sensible intervention strategies to enhance safe and independent bathing among community-living older persons.
The Specific Aims of the research proposed in the current application, which has been extensively revised in response to the prior review, are: (1) to determine the burden and patterns of disability in bathing among community-living older persons; (2) to determine whether disability in bathing is associated with subsequent adverse outcomes, such as nursing home admission and death, independent of potential confounders, including disability in other basic activities of daily living (ADLs); (3) to evaluate the relationship between potential risk factors that are intrinsic to the individual, especially those that may be modifiable, and disability in bathing; and (4) to identify potential environmental impediments to independent bathing. To accomplish these aims, we will use high quality data from an ongoing prospective study of 754 community-living older persons, including monthly assessments of ADL function for 7 years and comprehensive home-based assessments at 18-month intervals. The proposed research addresses a fundamental problem in geriatric medicine and rehabilitation, builds upon a large body of previously completed work, including epidemiologic studies related to ADL disability and the home environment, and takes advantage of the most comprehensive and complete set of bathing related data on such a large cohort of community-living older persons, with an excellent participation rate and remarkably low attrition. By rigorously evaluating the epidemiology of bathing disability, the research proposed in this revised application will facilitate the development of subsequent interventions directed at the prevention and remediation of disability in bathing. ? ?
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