bathtub-transfer-older-adults
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A bathtub transfer is the movement of getting into and out of a bath, which means lifting the feet over the rim and shifting body weight from one side to the other. Two sources checked for this guide describe that movement in different ways. A laboratory study counted how often participants stepped over the rim while they installed grab devices, and it recorded the forces those devices had to carry. A qualitative interview study asked older adults and their carers about bathing before and after the bath was replaced with a level-access shower. Neither source measured falls during a transfer, so this guide reports what each one measured.
Quick answer
- In the installation study, 35% of participants stepped over the rim at least once while installing the suction cup handhold, and 40% did so while installing one tub rail. The paper says that one in three participants completed a transfer before finishing the handhold installation, and that this “puts them at risk for a fall.”
- The paper applied 112.5 N to the handhold and 280.5 N to the rails. It links these values to loads recorded in an earlier study during bathtub exit.
- In the interview study, some older adults described needing help from another person to transfer in and out of the bath before the adaptation.
- Neither source counted falls during a transfer, and neither tested transfers in a home bathroom.
What a bathtub transfer asks of the body
The installation paper calls bathing one of the highest-risk activities at home for older adults. Its introduction states that “Bathing is one of the highest risk at-home activities for older adults”, and it cites earlier work for that statement. It also notes that “bathing-related disability is associated with requirement of home care services” Both statements come from the authors’ background section, and the study does not examine them.
In the study, a transfer meant stepping over the rim of the tub. The tub used was 41.3 cm tall, and the installation task required participants to move between the inside and the outside of the bath. The authors measured this movement during the installation task. They did not ask participants to take a bath.
Transfers during installation
Each participant installed the handhold and one of two rim-mounted tub rails in a laboratory alcove, and the researchers recorded every entry and exit with video. A transfer was counted when both feet moved from inside the bath to outside it, or the reverse. The results section reports that “While only 10% of participants completed a transfer during installation of Rim-Mounted Tub Rail B, 35% of participants completed a transfer when installing the Suction Cup Handhold, and 40% completed a transfer when installing Rim-Mounted Tub Rail A”
| Device being installed | Participants who completed at least one transfer (as reported) |
|---|---|
| Suction cup handhold | 35% |
| Rim-mounted tub rail A | 40% |
| Rim-mounted tub rail B | 10% |
The paper’s discussion gives the same finding in rounder terms. “one in three participants completed a transfer across the bathtub rim at least once before finishing the handhold installation, which puts them at risk for a fall.” The 35% figure is the result for the handhold. The authors do not state the number of participants, so the figures are reported as percentages.
The authors also describe the conditions of the transfer. The tub was empty, and participants could keep their shoes on. The paper says that “the transfer still carried a non-zero risk of slipping on the bathtub surface, or tripping or losing balance while crossing the bathtub rim.” It adds that “The risk of slipping would increase if the bathtub contained residual soapy water from a drained bath.” A bath with water in it was not tested.
The forces the devices had to carry
The paper applied a downward force of 112.5 N to the handhold and a downward and lateral force of 280.5 N to each rail. The authors say these values are “consistent with the loading observed by Greene and colleagues” during an unperturbed bathtub exit. The earlier study’s figures were 8.9% of body weight for a vertical grab bar and 22.2% of body weight for a rim-mounted tub rail, scaled to a 95th percentile male. Those figures come from the earlier study, which this guide does not examine.
The discussion ties the handhold figure to a specific situation. The authors write that the load of 115 N is “consistent with the load applied to a vertical grab bar during bathtub exit with no perturbation or loss of balance” For the rails, they make the same comparison with a rail during exit with no perturbation. The paper then makes a point about the cases it did not examine. “The loading requirements would be greater still during loss of balance” The authors also say that loads during non-falling transfers “would be greater than estimated by the current cohort”, because the participants were similar to those in earlier transfer studies.
The results of the load test were these. Three of the 20 handhold installations failed. The results section reports that “19 (95%) of Rim-Mounted Tub Rail installations failed mechanical load testing.” The discussion also says that “none of the Rim-Mounted Tub Rails withstood the 280 N force” The abstract says no rim-mounted tub rail was installed successfully. The paper gives no explanation for the difference between the results section and the abstract, and this guide does not resolve it.
Where the handhold sits and why it matters for a transfer
The Canadian standard the authors cite recommends a vertical grab bar on the control wall for entering and leaving the tub, and a horizontal bar on the back wall for support while bathing. In the study, only 40% of participants placed the handhold on the control wall or opposite it. More than half placed it on the back wall, which the paper calls an unusable location for entry and exit.
The authors write that the back-wall position “presents a safety concern if used for entry/exit transferring purposes as the user must lean over in order to reach it” They explain that “greater trunk flexion is associated with poorer center of pressure control” and that it “can increase the risk of falls”, citing earlier studies. The paper also notes that some participants chose the back wall because it helped with hair washing, or because they felt they needed stability when closing their eyes or tipping their head back.
What the interview study found about transfers
The second source is a qualitative interview study called BATH-OUT. Its participants were aged 65 or over and had been referred for an accessible showering facility, which the authors describe as a flush-floor, anti-slip “level access” shower, sometimes called a wet room. The bath or shower cubicle was removed and replaced. The study is therefore about the removal of the step, not about a transfer aid.
The study interviewed 21 older adults and five carers between December 2016 and August 2017. The older adults were aged 66 to 85, with a mean of 74.9 years. Their mean Barthel Index score was 17 out of 20, which the authors describe as largely independent but starting to struggle with one or two daily living tasks. Most lived alone in council-owned housing.
Before the adaptation, many described difficulty getting in. One participant said, “Struggling getting in, with my legs. And I wasn’t confident in getting in the bath.” The authors report that “some of the older adults reported that their previous difficulties were such that they needed help from another person to provide either physical assistance to transfer in and out of the bath or supervision” Another participant said, “I wouldn’t dare have a shower before, before they did this. I was too frightened, I just felt I’d go down you know, trip over and go down.”
After the change, participants described the overall effect as ease of use. The authors write that “Removal of physical barriers in the bathroom led to a sense of ‘freedom’ impacting physical functioning, confidence and quality of life” This is a description of how people felt, based on interviews. The study did not measure transfer movements, falls or any other safety outcome.
What the transfer evidence does not show
Neither source counts falls during a transfer. The installation study measured installation, not balance. The interview study reports how participants felt, and it does not report how often they moved in and out of the bath.
The authors say they “evaluated only one bathtub”, with one wall surface they describe as ideal, and three devices, and that “Installation strategies and performance of these assistive devices may differ in actual home bathing environments.” The participants were also allowed to keep their shoes on, and the study did not include wet surfaces.
The interview study had its own limits. The authors write that “The main limitation of this study is that it was conducted within one local authority area with a majority of participants living alone and in publicly owned housing stock.” Carers were hard to recruit, and only five took part. The authors also note that older adults who lived alone were more willing to be interviewed.
Neither source compares a transfer aid with a level-access shower, so neither can say which is safer for a given person.
What the transfer evidence suggests for readers
The sources do not rank bathing products, and this guide does not recommend any. The points below are drawn from what the studies measured.
- Plan for the step over the rim. The study found that people stepped over the rim while installing devices, and the authors say this carries a risk of slipping or tripping.
- Keep the tub dry during a transfer. The paper says residual soapy water increases the slip risk, though this was not tested.
- Consider where a support sits. The standard the authors cite places an entry-exit support on the control wall, and the study found that the back-wall position needed a lean to reach.
- Check whether the support is rated for the load. The authors’ figures suggest that a vertical support for exit may need to carry about 115 N, and a rim-mounted rail about 280 N, with no loss of balance.
- Note that the interview participants described a change from needing help to managing alone. That change came from removing the bath, not from fitting an aid, so the interview study does not show how much an aid alone would change.
How we chose
This guide uses two sources. Both are full-text articles in PubMed Central, and both were opened on 2026-10-28. The installation study was chosen because it records transfers, which the other sources do not. The interview study was chosen because it describes help with bath transfers among older adults, from the people who needed the help and from the carers who gave it. The two sources were chosen to cover different parts of the question. They were not ranked against each other.
What the sources do not say
- How often older adults fall while getting in and out of a bath in their own homes. The installation study counted transfers in one laboratory tub, and the interview study did not count transfers.
- Whether a bath with water in it changes the risk of a transfer. The installation study tested an empty tub.
- Whether the 280.5 N load used in the test represents the force a rail carries in a real fall. The authors say the loads during loss of balance would be greater.
- How the results for the rim-mounted tub rails should be read. The abstract says none was installed successfully, while the results section reports 19 of 20 failures, and the paper does not explain the difference.
- Whether level-access showers are safer than baths for every older adult. The interview study covered 21 people in one local authority area.
Sources
- Rand M, Pelchat J, Levine IC, Montgomery RE, Greene RM, King EC, Pong SM, Novak AC. Efficacy of Installation of Temporary Bathing Transfer Aids by Older Adults. Gerontology and Geriatric Medicine. 2024;10:23337214241237119. https://pmc.ncbi.nlm.nih.gov/articles/PMC10938608/ (opened 2026-10-28)
- Whitehead PJ, Golding-Day MR. The lived experience of bathing adaptations in the homes of older adults and their carers (BATH-OUT): A qualitative interview study. Health and Social Care in the Community. 2019;27:1534-1543. https://pmc.ncbi.nlm.nih.gov/articles/PMC6851978/ (opened 2026-10-28)
