Why Are Bathtubs Risky for Older Adults — and How to Fix It

To-the-point

Traditional bathtubs are risky because they combine a high step-over with wet, slippery surfaces, awkward transfers, and scalding hazards. The safest fixes: add proper grab rails, a bath board or transfer bench, wet-rated anti-slip (target PTV ≥36), thermostatic mixing valve for safe temperature, and bright lighting—or replace the bath with a walk-in bath or level-access shower when transfers are hard or carer access is needed.

1) Hidden dangers of bathtubs

• High step-over: typical UK bath height is ~510–550 mm, which many older adults struggle to clear safely—especially when tired or unwell.

• Slippery surfaces: soapy water and smooth enamel/acrylic increase slip risk. (See PTV thresholds below.)

• Scalding: water from taps > 44 °C can scald; healthcare guidance limits mixed outlet temps to ≈41 °C (showers) and ≈44 °C (baths). Domestic TMV2 guidance commonly uses 46 °C for baths. Fit a TMV.

• Transfers & fatigue: sitting down into and up from a low tub is hard; loss of balance is common in bathrooms.

UK falls picture: about 1 in 3 people 65+ and ~1 in 2 people 80+ fall yearly; fall-related emergency admissions for 65+ in England were ≈210,000 in the latest data.

2) Fall risk factors inside the bath area

• Wet floor & overspray (no screen/deflector).

• Poor lighting or glare (hard to see edges).

• No safe hand-holds at entry/exit or where you sit.

• Rushing (especially night-time toileting).

• Medicines/vision changes affecting balance. (NHS prevention advice emphasises home modifications and strength/balance.)

3) Affordable modifications 

Low-disruption add-ons your OT or installer can fit quickly:

• Grab rails at entry, seat, and exit points (fixed into structure, not suction only).

• Bath board (across the rims) or transfer bench (straddles the rim) to enable sit-and-swivel entry.

• Hand-held shower + return/deflector panel to keep spray in.

• Wet-rated anti-slip surface; aim for PTV ≥ 36 in wet areas; clean routinely so the texture grips.

• TMV (TMV2/TMV3) to control hot-water temperature and prevent scalds.

• Lighting (even, bright) and a night-light path.

4) Walk-in baths vs bath lifts (which makes sense when?)

• NHS/Home-adaptations guidance recognises bath lifts/boards as practical options to enable safe bathing.

• Independent reviews note longer fill/drain times and maintenance as common walk-in bath downsides — factor this into decisions.

5) When to replace your bath (decision signals)

Replace the bath (or re-plan the bathroom) when one or more are true:

• Repeated near-misses or a fall getting in/out.

• A carer needs space to assist safely (bath rim blocks transfers).

• You cannot step over ~510–550 mm even with rails/board.

• Progressive condition (e.g., balance, strength) and you want to future-proof.

• Persistent overspray/pooling you can’t solve with screens and drainage.

Replacement options:

• Walk-in bath if soaking is important and you’re comfortable with longer fill/drain times.

• Level-access shower (often the safest, lowest-maintenance choice for many homes).

6) Advice for caregivers 

• Use sit-to-stand and sit-and-swivel transfers (board/bench). Keep one hand on a fixed rail.

• Check water with a thermometer (or elbow) before the person enters; fit TMV to keep temperatures safe (healthcare: ~44 °C bath; domestic TMV2: 46 °C).

• Never leave a high-risk person unattended in the bath.

• Keep a call device/phone within reach; avoid locking doors.

Modification vs replacement — at-a-glance

What “anti-slip” means in the UK (PTV)

PTV (Pendulum Test Value) → slip risk classification (HSE/UKSRG)

Your challenge	Quick modification (low disruption)
0–24	High slip potential
25–35	Moderate slip potential
36+	Low slip potential (target for wet areas)

Aim for PTV ≥ 36 on wet floors (inside the bath/shower area and around it).

Safety checklist 

• Grab rails (entry/seat/exit) fixed into structure

• Bath board / transfer bench if stepping over is hard

• Anti-slip surface (PTV ≥ 36) and routine cleaning

• Return/deflector panel; shower aimed inward

• TMV fitted; test temperature before bathing

• Bright, even lighting + night-light route

• Decluttered floor; remove loose mats/cables

• Plan for tomorrow: if needs are changing, consider a walk-in bath or level-access shower

FAQs

Why are tubs riskier than showers for older adults?
The high step-over (~510–550 mm) and slippery surfaces make transfers harder than a level-access shower. Add rails/board—or consider replacement if transfers remain risky.

How hot is “too hot” for bath water?
There’s scald risk above 44 °C; healthcare guidance limits baths to ≈44 °C and showers to ≈41 °C. Domestic TMV2 guidance often uses 46 °C for a bath outlet—fit a TMV and check the temperature.

Is a walk-in bath better than a bath lift?
It depends. Walk-in baths give low-threshold soaking but take longer to fill/drain. Bath lifts/boards are quicker, cheaper and use your existing tub. Choose based on mobility, patience with fill/drain times, and preference for soaking.

Where can I get help with equipment?
Ask your local authority for a home assessment; NHS guidance covers adaptations such as bath lifts and rails.