title: Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap).
  
  
  METHODS
  A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover.
  
  
  METHODS
  Nine skilled nursing facilities in Oregon and six in North Carolina.
  
  
  METHODS
  Seventy-three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them.
  
  
  METHODS
  Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora.
  
  
  RESULTS
  All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person-centered shower group (P<.001) and 60% in the towel-bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person-centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans.
  
  
  CONCLUSIONS
  Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia.
authors.affiliation: Department of Family Medicine, Cecil G.Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27499, USA. psloane@med.unc.edu
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Beverly
authors.initials: B
authors.lastname: Hoeffer
authors.forename: C Madeline
authors.initials: CM
authors.lastname: Mitchell
authors.forename: Darlene A
authors.initials: DA
authors.lastname: McKenzie
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Barrick
authors.forename: Joanne
authors.initials: J
authors.lastname: Rader
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stewart
authors.forename: Karen Amann
authors.initials: KA
authors.lastname: Talerico
authors.forename: Joyce H
authors.initials: JH
authors.lastname: Rasin
authors.forename: Richard C
authors.initials: RC
authors.lastname: Zink
authors.forename: Gary G
authors.initials: GG
authors.lastname: Koch
mesh_terms: D000368:Aged; D000374:Aggression / Q000523:psychology*; D001494:Baths / Q000379:methods* / Q000451:nursing; D001512:Bedding and Linens; D018592:Cross-Over Studies; D003704:Dementia / Q000451:nursing / Q000523:psychology*; D005260:Female; D005851:Geriatric Nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D018802:Patient-Centered Care / Q000379:methods*; D011595:Psychomotor Agitation / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014743:Videotape Recording