Bathing and Toileting Difficulty of Chinese Older Adults: The Role of Environment

Abstract Background: For older adults, difficulties in bathing and toileting are often the most prevalent in the index of Activities of daily living (ADL). Few studies, however, have investigated how the built environment and other environmental factors affect bathing and toileting in later life. This study aims to fill this gap. Method: The data are from the 2014 Thousand-Village Survey (TVS), a national survey of Chinese rural residents of old age. The sample consists of 10,689 subjects, 55 years or older, from 536 villages across all provinces of China. The multinomial logistic regressions were applied to examine how difficulty in bathing and toileting was related to environmental factors such as geographic location, community amenity, and built environment of bathing and toileting. Results: Older adults living in the southern regions of China had lesser difficulty in bathing and toileting than those living in Northern China, controlling on other confounders. Better community conditions also reduced the likelihood of having such disabilities. Persons who bathed indoors without shower facilities, in public facility, and outdoors were significantly more likely to have bathing disability than those who showered indoors. Rural older adults who used pedestal pan and indoor bucket for toileting were more likely to have toileting disability than those who used indoor squatting facilities. Conclusion: Environmental factors are strongly associated with functional disability among older adults, but the relationship is not unidirectional. Having a showering facility could reduce difficulties of bathing for rural Chinese. Very frail older persons may actively choose to change their environmental settings to suit their needs, for instance, by using a pedestal pan or bucket for toileting as an alternative to squatting. There is an urgent need to promote the use of showering facilities and pedestal pans for toileting in rural China.