Older adults who struggle to bathe are five times more likely to develop further disabilities, yet the assistive technologies meant to help them—grab rails, shower chairs, bath lifts—are provided through a fragmented system with little evidence on what works best. This research tackles a blind spot in adult social care. While major home adaptations like level-access showers have been studied, the cheaper, quicker equipment and minor adaptations that could keep people independent have not been rigorously evaluated for effectiveness or cost-effectiveness. The team will track 430 older adults across eight local authorities with different waiting times, measuring physical function, independence, and quality of life over up to six timepoints. They will also map the entire assessment-to-provision pathway across 30 local authorities and interview 60 older adults about their experiences. If successful, the project will produce implementable recommendations to standardise the bathing equipment pathway, reducing the current postcode lottery of waiting times and provision. A linked budget impact analysis will show local authorities the financial case for investing in these technologies—potentially preventing further deterioration that leads to more expensive care. A separate PhD study will examine the impact on carers, a group often overlooked in equipment provision decisions.
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Background The onset of disability in bathing is associated with a fivefold likelihood of increase in disability in another daily living activity for older adults. Adult social care (ASC) interventions for bathing include assistive technology (AT) devices such as compensatory equipment, minor or major adaptations. There is limited research on the effectiveness and cost effectiveness of these ATs to support bathing, including whether they prevent further deterioration or use of additional services. Furthermore, there are variations between social care services in their processes and waiting times for provision. Aims and Objectives We aim to produce recommendations and resources to maximise the effectiveness of the pathway for the assessment and provision of ATs to support bathing for older adults. We aim to evaluate the effectiveness and cost effectiveness of equipment and minor adaptations to support independence in bathing and combine this with our ongoing work on major adaptations. We will also explore the pathway to assessment and provision, older adults experiences of the ATs and the pathway, and the financial implications of investing in ATs. Methods We will work in collaboration with two insight panels of 12 people with lived experiences and 12 people with practice experiences to synthesise findings and co-develop a range of resources and accessible outputs (WP1). We will map the adult social care bathing pathway via case studies of up to 30 local authorities, with linked document analysis. We will also carry out in-depth interviews with up to 60 older adults using ATs for bathing (WP2). We will conduct a prospective cohort study, with an embedded cost-effectiveness analysis, to evaluate the impact of ATs for bathing on physical functioning, independence and quality of life. 430 older adults from eight local authorities with varying waiting-times will complete a range of assessments at up to six timepoints. We will also carry out a systematic review and Individual Participant Data (IPD) Meta-Analysis, pooling the data from this study with our work on major adaptations and other studies (WP3). We will develop a Budget Impact Analysis (BIA) and undertake a Multi-Criteria Decision Analysis (MCDA) to understand both the financial implications of investing in ATs for bathing, stakeholders prioritisation criteria and their relative importance (WP4). Finally, we develop and rapidly evaluate strategies, recommendations and resources to implement changes in the ASC bathing pathway using mixed-methods (WP5) A linked PhD studentship will focus on the impact of ATs for bathing on the carers of older adults and will recruit ~100 carers to complete assessments with a sub-sample for in-depth interview. Timelines for delivery We propose a programme of 60-months. WP1 will run throughout, WP2 for 18-months, WP3 for 48-months, WP4 for 12-months, WP5 for 26-months. The PhD studentship will last 36-months. Anticipated impact and dissemination We will work with both insight panels to share our findings and design activities to increase impact for public, practice, policy and academic audiences. We aim to produce implementable recommendations to reduce the variations between services and associated inequalities.
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