Do the Americans With Disabilities Act Grab Bar Recommendations Best Meet the Needs of Older Adults? A Pilot Study

PURPOSE: This study sought to answer the question, Does a bilateral grab bar design better meet the needs of older adults than the recommended Americans With Disabilities Act (ADA) Accessibility Guidelines grab bar design found in public settings? Recently, American society has been experiencing a demographic shift, resulting in the growth of the population of older adults. Occupational therapists can make recommendations to modify the environment of their clients to maximize their safety, function, and independence. The physical changes that accompany aging have been associated with an increased risk of falls in the elderly. Grab bars compensate for declines in physical skills such as balance, coordination, and strength. Transferring on and off the toilet poses a risk for falls in older adults.

DESIGN: This experimental study used a sample of 13 community-dwelling adults over age 60 who were English speaking, scored 16 or higher on the Montreal Cognitive Assessment (MoCA)–Blind, weighed less than 300 lb, and were able to walk 25 ft with or without a mobility aid. Participants were recruited based on their availability. Additional participant data will be collected throughout the 2016–2017 academic year.

METHOD: Data were collected using the Demographic Interview, the MoCA–Blind, Physical Fitness Test, Tinetti Performance Oriented Mobility Assessment, researcher observation, and participant self-report using a visual analog scale. The Demographic Interview assessment was developed by the primary researcher as a demographic data collection tool. The MoCA–Blind was used to determine eligibility for the study. The Physical Fitness Test assesses upper- and lower-body strength and flexibility. The Tinetti Performance Oriented Mobility Assessment was used to evaluate participants’ functional mobility.

Participants performed four sit-to-stand toilet transfer trials using two grab bar designs. The researchers rated each transfer using a data collection record sheet. During the first trial, an ADA-compliant grab bar design was used. During the second trial, a bilateral grab bar design was used. Participants rated the safety and function of the grab bar designs using a visual analog scale. Participants traveled to the University of Scranton or the researchers traveled to participant’s homes for data collection. Scores and results were calculated for each instrument and were entered into IBM SPSS Statistics for each participant. Both correlational and descriptive tests were run. Comments and observations were grouped into themes.

RESULTS: There was a moderate correlation of –.479 between the use of ADA grab bars and higher physical fitness test scores. Based on descriptive analyses, 38% of participants used the ADA grab bars, and only when they were more physically fit, while 85% of participants used the bilateral grab bars, which was not correlated with levels of physical fitness.

CONCLUSION: This pilot study began as an investigation into whether or not the ADA grab bar design met the needs of the aging population and whether a bilateral grab bar design would better meet these needs. Through correlational and descriptive statistics, it was found that a bilateral grab bar design was used more often, and used regardless of physical fitness level. Further research is needed to identify why bilateral grab bars are more likely to be used. Private homes and facilities not mandated to comply with ADA legislation can use this information when selecting grab bars. The ADA guidelines may need to be adapted to meet the needs of a wider portion of the population.

IMPACT STATEMENT: The results of this study assert that bilateral grab bars can be used by people of various physical ability. Practitioners can use this information when recommending grab bar designs. As the population ages, the ADA guidelines may need to be adapted to meet society’s changing needs.

References

Kennedy, M. J., Arcelus, A., Guitard, P., Goubran R. A., & Sveistrup, H. (2015). Toilet grab-bar preference and center of pressure deviation during toilet transfers in healthy seniors, seniors with hip replacements, and seniors having suffered a stroke. Assistive Technology, 27, 78–87. https://doi.org/10.1080/10400435.2014.976799

Morales, E., Rousseau, J., & Passini, R. (2011). Bathrooms in retirement residences: Perceptions and experiences of seniors and caregivers. Physical and Occupational Therapy in Geriatrics, 30, 1–21. https://doi.org/10.3109/02703181.2011.644656

Pfauth, R. C. (2011). Accessibility for elders: What’s ADA got to do with it? Unpublished thesis, American Institute of Architects, Washington, DC.