The best evidence for assisted bathing of older people with dementia: a comprehensive systematic review
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
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 Search strategy The search aimed to identify both published and unpublished studies from 1990 to April 2011.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. Implications for practice The use of the person-centred showering approach, towel bath/thermal bath and preferred music of older adults are recommended. Caregivers should have relevant assessment skills of triggers to agitation and good communication skills. A flexible and creative care plan and organisational supports are necessary. Implications for research Further controlled trials are required to determine the effectiveness of various bathing methods, alternative bathing products and any other interventions to improve the experiences of both people with dementia and caregivers who bathe them. However, due to ethical issues, it may not be realistic to conduct rigorous controlled trials in this field of aged care practice. Instead, high quality interpretive studies that can document and evaluate the practical knowledge and experiences of caregivers concerning assisted bathing of older adults with dementia are needed.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it