When bathing leads to drowning in older adults

Pre-Existing Medical Conditions: A Systematic Literature Review of a Silent Contributor to Adult Drowning

Medical conditions can increase drowning risk. No prior study has systematically reviewed the published evidence globally regarding medical conditions and drowning risk for adults. MEDLINE (Ovid), PubMed, EMBASE, Scopus, PsycINFO (ProQuest) and SPORTDiscus databases were searched for original research published between 1 January 2005 and 31 October 2021 that reported adult (≥15 years) fatal or non-fatal drowning of all intents and pre-existing medical conditions. Conditions were grouped into the relevant International Classifications of Diseases (ICD) codes. Eighty-three studies were included (85.5% high-income countries; 38.6% East Asia and Pacific region; 75.9% evidence level III-3). Diseases of the nervous system (n = 32 studies; 38.6%), mental and behavioural conditions (n = 31; 37.3%) and diseases of the circulatory system (n = 25; 30.1%) were the most common categories of conditions. Epilepsy was found to increase the relative risk of drowning by 3.8 to 82 times, with suggested preventive approaches regarding supervised bathing or showering. Drowning is a common suicide method for those with schizophrenia, psychotic disorders and dementia. Review findings indicate people with pre-existing medical conditions drown, yet relatively few studies have documented the risk. There is a need for further population-level research to more accurately quantify drowning risk for pre-existing medical conditions in adults, as well as implementing and evaluating population-level attributable risk and prevention strategies.

Force applied to a grab bar during bathtub transfers

BACKGROUND

Grab bars are a common fall prevention strategy in the bathroom, but biomechanical data are lacking to support clinicians' interventions. This study aims to determine the magnitude and duration of the force applied to four grab bar configurations during complete bathtub transfers on a potentially slippery surface.

METHODS

A three factorial repeated measures design was used in an experimental environment including a bathtub, padded walls, instrumented fixed grab bars and a safety harness. Seven healthy young adults stepped into the bathtub, sat down at the bottom, stood up and stepped out (three trials), with or without a slippery surface, grabbing onto four grab bar configurations (vertical, angled, horizontal low, horizontal high). Maximum force magnitudes and durations during bathtub transfers were measured by two 6-degrees of freedom load cells.

FINDINGS

On average, 23.2 ± 6.4% of body weight was applied on the grab bar during complete bathtub transfers. Maximum resultant forces were not influenced by grab bar configuration, presence of a slippery surface, or direction of bathtub transfer (entrance or exit), except for the vertical configuration without a slippery surface where the maximum resultant force was smaller than for the three other configurations. Transferring on a slippery surface increased the time participants applied force on the grab bars.

INTERPRETATION

Grab bars used during complete bathtub transfers with no loss of balance should be capable of sustaining a minimum of 23.2% of body weight, to which a factor of safety of 1.5 should be added, regardless of the grab bar configuration.