Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Abstract

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives: To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods: We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. Selection criteria: We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis: Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Main results: Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR ...

The relatives’ voice: how do relatives experience participation in reablement? A qualitative study

“…Reablement is an early and time-limited home-based intervention with an emphasis on intensive, goal-oriented, and interdisciplinary support and assistance for older adults experiencing functional decline 1. There has been growing international interest in reablement or restorative care as a new rehabilitative approach for the elderly 1,2.…”

“…There has been growing international interest in reablement or restorative care as a new rehabilitative approach for the elderly 1,2. When rehabilitation takes place in the home, as opposed to an institution, relatives often become more involved and have an important role as physical and emotional supporters in promoting the rehabilitation process 3…”

“…However, reablement means home-based rehabilitation and is not institution- or hospital-based. A coordinated multidisciplinary team and home-care services work together with the older adults toward shared goals, which is one of the main characteristics of reablement 1,2,5…”

Predictors of outcomes following reablement in community-dwelling older adults

“…It has been seen as a solution to a number of long-standing challenges in health care, including the cost pressures associated with a rapidly aging population, and is therefore being implemented in a growing number of countries 1. There is limited evidence, although not conclusive, that reablement leads to improved function in daily occupations, physical function and health-related quality of life for home-dwelling older adults2–5 and to reduced costs and decreased demand for public health care services 4–6…”

“…The rehabilitation model is goal-orientated, holistic and person-centered, designed to achieve goals that matter to each individual 1,5. The approach is multidisciplinary in nature and aims to help home-dwelling older people live independently and in fulfilling lives following functional decline, while simultaneously reducing the need for continuing support and long-term services 2.…”