Effect of the bathing without a battle training intervention on bathing-associated physical and verbal outcomes in nursing home residents with dementia: a randomized crossover diffusion study.
OBJECTIVE
To evaluate the effectiveness of the Bathing Without a Battle intervention in reducing physical and verbal aggressive behaviors for nursing home residents with dementia.


METHODS
A randomized crossover diffusion study, with one group receiving the intervention after one round of baseline observations and a delayed intervention group receiving the intervention after two rounds of baseline observations.


METHODS
Six nursing home facilities in the state of New York.


METHODS
Nursing home residents with dementia (N = 240).


METHODS
The Bathing Without a Battle educational program, designed for direct-care staff members responsible for bathing residents diagnosed with dementia and implemented through a train-the-trainer model.


METHODS
Rates of verbal and physical aggressive and agitated behaviors were measured using the Care Recipient Behavior Assessment; secondary measures of effect included bath duration, bath modality, and antipsychotic medication use.


RESULTS
In spite of implementation obstacles (consent delays and change in leadership at one facility), a significant change was observed in how residents were bathed that translated into a significant reduction in the rate of aggressive and agitated behaviors, particularly verbal, during residents' baths. The use of in-bed baths increased 17%, and average bath duration decreased significantly (average 1.5 minutes less) in the postintervention period, particularly for in-bed baths. Verbal behaviors declined 17.8% (P = .008), combined verbal and physical behaviors declined 18.6% (P = .004), and antipsychotic use declined 30% (P = .002) after the intervention.


CONCLUSIONS
The Bathing Without a Battle educational program, delivered through a train-the-trainer format, is an effective means of improving the bathing experience of residents with dementia in nursing homes. This research supports broadly adopting this intervention, especially for nursing homes serving many residents with dementia.
Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island; Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.
Pedro
P
Gozalo
Shivaani
S
Prakash
Danya M
DM
Qato
Philip D
PD
Sloane
Vincent
V
Mor
D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D001494:Baths / Q000379:methods* / Q000523:psychology; D018592:Cross-Over Studies; D003704:Dementia / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes; D011595:Psychomotor Agitation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014705:Verbal Behavior
Alzheimer's; aggressive behaviors; bathing; dementia