Assisted bathing of older adults with dementia: a mixed methods systematic review update
Authors: Konno Rie , Suzuki Miyuki , Hosomi Akiyo , Lizarondo Lucylynn , Stern Cindy 
Published: December 2023

Objective:
This review update aimed to determine the best strategies for assisted bathing or showering for older adults with dementia.

Introduction:
Assisted bathing is a high-risk activity, as it can trigger agitated behaviors. Assisted bathing of older adults with dementia can create caregiver challenges and stress.

Inclusion criteria:
This review update considered quantitative, qualitative, and mixed methods studies that investigated, firstly, older adults with dementia who required assistance in bathing and, secondly, their caregivers and family members who provided this assistance. The quantitative component considered randomized controlled trials and quasi-experimental studies testing interventions for reducing agitated behaviors in older adults with dementia during bathing, as well as perceived confidence or satisfaction in caregivers. The qualitative component considered studies that reported on experiences of clients or caregivers during the bathing process.

Methods:
A JBI mixed methods review was conducted following the convergent segregated approach. The review considered studies published between 1990 and March 11, 2022. The databases searched were PubMed, CINAHL, and Embase. Gray literature was also searched. Two independent reviewers screened titles and abstracts. Full texts were retrieved for studies that met the inclusion criteria and were assessed further for eligibility. Two reviewers independently assessed the quality of included studies and extracted data using the standardized JBI tools. Due to methodological and clinical heterogeneity, the results were presented in narratively in the quantitative section. For the qualitative component, meta-synthesis was conducted following the JBI approach of meta-aggregation. Finally, evidence from the 2 components was integrated following the convergent segregated approach.

Results:
Ten quantitative and 4 qualitative studies were included. The methodological quality was poor to moderate in the quantitative studies and moderate to high in the qualitative studies. Results from 3 quantitative studies suggested that providing training to caregivers on person-centered bathing reduced agitated behaviors in older adults with dementia. Other interventions did not show conclusive evidence of their effectiveness in any outcomes of interest. Two synthesized findings highlighted i) the importance of working within each person’s reality by having the skills and knowledge required to deliver person-centered assistance and ii) the challenges experienced by caregivers, such as lack of support, time pressure, and safety-related fears. The integrated evidence showed that the quantitative and qualitative components complemented each other to promote the training of caregivers to deliver person-centered bathing.

Discussion:
Integrated findings can help inform an evidence-based strategy utilizing a person-centered bathing approach to reduce agitated behaviors in older adults with dementia. Due to the limited number of eligible studies, and the clinical and methodological heterogeneity of included quantitative studies, no statistical pooling was possible. More studies are needed, particularly intervention studies with high methodological quality.

Conclusions:
This review update suggests that providing caregivers with person-centered bathing training should be encouraged prior to bathing older adults with dementia. Caregivers should have knowledge and skills, such as relevant assessment and communication skills, enabling them to provide effective bathing experiences to older adults living with dementia. Organizations should provide caregivers with appropriate resources and training for bathing older adults with dementia.

Review registration:
PROSPERO CRD42020208048

Supplemental Digital Content:
A Japanese-language version of the abstract of this review is available as Supplemental Digital Content 1, http://links.lww.com/SRX/A37.