The BATH-OUT study is a feasibility randomised controlled trial with nested qualitative interview study. It involves adults aged 65 or over, and their carers, who have been assessed by a social care occupational therapist and referred for an accessible showering facility. We want to investigate the impact of the accessible showering facility on disabled older adults and their carers. The researchers' long term aim is to evaluate the effect of these adaptations on quality of life, health and wellbeing and functional ability.

1. BATH-OUT
Bathing Adaptations in the Homes of Older Adults: A feasibility
Randomised Controlled Trial with nested qualitative interview study
Dr Phillip Whitehead, Mrs Miriam Golding-Day, Prof Marion Walker MBE,
Prof Marilyn James, Mr Tony Dawson and Mr Stuart Belshaw
@bath_outbath-out@nottingham.ac.uk
The BATH-OUT study is funded by the National Institute for Health Research’s School for Social Care Research (IRAS PROJECT ID: 200842). ISRCTN Registration 14876332. The views in this
publication are those of the researcher’s and not necessarily of the NHS, NIHR or the Department of Health.
www.nottingham.ac.uk/go/bath-out

2. Background
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Housing Adaptations –
‘Top-10’ prevention (Allen
& Glasby, 2013)
Limited robust evidence
(Whitehead et al, 2016; Golding-
Day et al, in press)
Waiting times up to 2 years
(Leonard Cheshire Disability,
2015)
Bathing – sentinel point in
disabling process (Gill et al,
2006)
Continuing funding
uncertainties

3. Study Overview
• BATH-OUT is RCT feasibility study to inform whether a larger scale
study would be possible
• First randomised study of housing adaptations in UK – waiting list control
• Looking to address key questions about bathing adaptations such as:
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Do they lead to
reductions in use of
other health and social
care services?
Do they improve
service user and carer
QoL?
Do waiting times for
them lead to poorer
outcomes and increased
costs?

4. Study Structure
Feasibility RCT
Qualitative Interviews
Objective One
Evaluate feasibility of using RCT with waiting
list controlObjective Two
Explore practices and processes from user
and carer perspectives
Systematic Review
Objective Three
Collate and evaluate existing
evidence/literature

5. Bathing Adaptations = Level Access
Shower
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6. Study Methodology
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Intervention = ‘jumping’ waiting list to have adaptations
provided ‘immediately’
Recruit via referrals from: Nottingham City Council
Adaptations & Renewals Agency
Control = usual care with ~ 4 month waiting list
Criteria: Citizen, Adult >65 years, Bathing disability, LAS
Only, Priority B status
Interviews conducted once shower in place to discuss
around LAS referral & its impact
3, 6 & 9 month follow ups – complete Nov 2017
Gill TM, Guo Z, Allore HG. The epidemiology of bathing disability in older
persons. J Am Geriatr Soc 2006;54:1524–30.
Carers: Friend or family member providing care and/or
assistance in ADL

7. 10/18/17 7

8. 10/18/17 8
Flow chart
9 Month Follow up Service User
and Carer
Assess for Eligibility
Approach for Consent
CONSENT/Consultee
Baseline Assessment
Service User and Carer
Randomisation
INTERVENTION
without waiting list
3 Month Follow up
Service User and Carer
6 Month Follow up Service User and Carer
CONTROL
waiting list (usual care)
6 Month Follow up Service User and Carer Adaptations
(usual care)
Not Eligible or No Consent –
treatment as usual
3 Month Follow up
Service User and Carer
9 Month Follow up Service User and Carer
Adaptations
(without waiting list)

9. Outcome Measures
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User Questionnaire
Health status/QoL (mental + physical
components) SF-36 & EQ5D
Social care related QoL ASCOT
Performance in ADL BARTHEL
Number falls, consequence & fear of falling
Falls Efficacy Scale
Carer Questionnaire
Health status/QoL (mental + physical
components) SF-36 & EQ5D
Carer strain and burden Carer Strain
Index
Health economic resource use Bespoke
pro forma

10. Feasibility Outcomes
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Can we recruit
participants?
Can we retain participants?
Can we deliver the adaptations in
the timescales?
Can we collect the outcome
data (including costs)?
What is the most suitable
primary outcome measure
for use in the main study?
What is the suitability and
sensitivity of outcome
measures?

11. Recruitment
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12. Follow Ups
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Number Participant’s Consented & Randomised
(60)
(83)% of those eligible
(100)% of those visited
3 Month Follow-up
Number (18)
(78)% Completed
9 Month Follow-up*
(7) Completed
Deceased (0)
Withdrew (2)
Lost to follow-up (4)
3 Month Follow-up
Number (54)
(90)% Completed
Deceased (2)
Withdrew (0)
Lost to follow-up (1)
9 Month Follow-up*
(24) Completed
Number of Participants with Carers
Consented
(23)
(59)% of those eligible
*live figures
6 Month Follow-up
Number (16)
(70)% Completed
6 Month Follow-up
Number (51)
(85)% Completed
Deceased (1)
Declined (4)
Lost to follow-up (0)

13. Qualitative Interviews
• Explore views and experiences of the difficulties that led to the
adaptations?
• What has been the impact (outcome) of the adaptations from
participants’ perspectives?
• What are their views on the adaptations process?
• What are their views on involvement in The BATH-OUT Study?
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Participant (n=21) Carer (n=5)

14. Qualitative Interviews
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Participant 013, male, immediate adaptations, describing his difficulties using the
previous set-up (overbath shower)

15. Qualitative Interviews
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Participant 041, female, immediate adaptations, describing her previous situation
and the impact of the level access shower on her life

16. Qualitative Interviews
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Participant 006, female, immediate adaptations, describing her previous situation
and the impact of the level access shower on her life

17. NEXT Steps…
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Further
discussion
regarding
outcomes
Submit full
study
funding
proposal –
mid 2018
4 – 5 sites;
~360
participants
(total)

18. Thank you for listening -
We welcome any
Questions
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bath-out@nottingham.ac.uk
@bath_out
www.nottingham.ac.uk/go/bath-out

19. References
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• Allen K, Glasby J. ‘The billion dollar question’: embedding prevention in older people’s
services—ten ‘high-impact’ changes. Br J Soc Work 2013;43:904–24.
• Gill TM, Guo Z, Allore HG. The epidemiology of bathing disability in older persons. J Am
Geriatr Soc 2006;54:1524–30.
• Golding-Day MR, Whitehead PJ, Radford K, Walker MF. Interventions to Reduce
Dependency in Bathing in Community Dwelling Adults: A systematic Review. Systematic
Reviews, in press.
• Leonard Cheshire Disability. The long wait for a home. London: Leonard Cheshire
Disability, 2015.