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Falland L, Henwood T, Keogh JWL, Davison K. Prioritising restorative care programs in light of current age care reform. Australas J Ageing 2024; 43:191-198. [PMID: 38268330 DOI: 10.1111/ajag.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Short-term restorative care (STRC) aims to reduce the demand for long-term aged care services through 8 weeks of intensive, multidisciplinary services designed to enhance the independence of community-dwelling older Australians at risk of functional decline. Evidence surrounding the effectiveness and feasibility of STRC is limited. OBJECTIVE This study aimed to examine the effectiveness of an existing exercise-based STRC model and help inform successful service delivery to maximise participant outcomes nationally. METHODS An observational cohort study was conducted to evaluate the potential benefits accrued by community-dwelling older adults accessing Southern Cross Care's current exercise-based STRC model in Adelaide, South Australia. Program effectiveness was determined via improvements in outcome measures specific to functional decline risk factors from baseline (Week 0) to discharge (Week 8). RESULTS Results demonstrated significant improvements (p < 0.001) in participants' (n = 62) lower extremity function (44.9%), depressive symptoms (52.4%), anxiety (45.8%), frailty stage (57.9%), independence in activities of daily living (17.3%) and health-related quality of life (24.0%). No significant change was found for grip strength or BMI post-intervention. The most frequent services were exercise-based (54.3% of total services), with participants receiving an average of two to three exercise services per week. CONCLUSIONS An exercise-based STRC model is an effective mechanism to reverse functional decline and associated risk factors among community-dwelling older Australians. Adoption of multidisciplinary intervention as a standardised STRC service model could help improve client outcomes nationally and offset expected increases in community and long-term aged care demand.
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Affiliation(s)
- Laura Falland
- Southern Cross Care (SA, NT & VIC), Adelaide, South Australia, Australia
- Alliance for Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Tim Henwood
- Southern Cross Care (SA, NT & VIC), Adelaide, South Australia, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Justin W L Keogh
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
- Human Potential Centre, AUT University, Auckland, New Zealand
- Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kade Davison
- Alliance for Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Olsson Möller U, Zingmark M, Ekstrand J, Haak M. The Content of Physiotherapy and Factors Impacting on Reablement - A National Study. J Multidiscip Healthc 2023; 16:3075-3088. [PMID: 37881528 PMCID: PMC10596052 DOI: 10.2147/jmdh.s415112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.
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Affiliation(s)
- Ulrika Olsson Möller
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Zingmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden
- Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Joakim Ekstrand
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Maria Haak
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Kattouw CE, Aase K, Viksveen P. Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study. BMC Geriatr 2023; 23:576. [PMID: 37726648 PMCID: PMC10508029 DOI: 10.1186/s12877-023-04303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question "What matters to you?". However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. METHODS Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. RESULTS Overall, there was considerable correspondence between the four stakeholder groups' perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) "self-reliance - living independently at home as long as possible"; (2) "remaining active and social within the community"; (3) "support for living at home as long as possible"; (4) "accessible information and services"; (5) "continuity of services"; and (6) "compassionate and competent healthcare professionals". CONCLUSIONS In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens' autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens' needs.
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Affiliation(s)
- Christophe Eward Kattouw
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway.
| | - Karina Aase
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
| | - Petter Viksveen
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
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Mouchaers I, Verbeek H, Kempen GIJM, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. Development and content of a community-based reablement programme (I-MANAGE): a co-creation study. BMJ Open 2023; 13:e070890. [PMID: 37648386 PMCID: PMC10471872 DOI: 10.1136/bmjopen-2022-070890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/19/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES As age increases, people generally start experiencing problems related to independent living, resulting in an increased need for long-term care services. Investing in sustainable solutions to promote independent living is therefore essential. Subsequently, reablement is a concept attracting growing interest. Reablement is a person-centred, holistic approach promoting older adults' active participation through daily, social, leisure and physical activities. The aim of this paper is to describe the development and content of I-MANAGE, a model for a reablement programme for community-dwelling older adults. DESIGN The development of the programme was performed according to the Medical Research Council framework as part of the TRANS-SENIOR international training and research network. A co-creation design was used, including literature research, observations, interviews, and working group sessions with stakeholders. SETTING AND PARTICIPANTS The interviews and working group sessions took place in the Dutch long-term home care context. Stakeholders invited to the individual interviews and working group sessions included care professionals, policymakers, client representatives, informal caregiver representatives, informal caregivers, and scientific experts. RESULTS The co-creation process resulted in a 5-phase interdisciplinary primary care programme, called I-MANAGE. The programme focuses on improving the self-management and well-being of older adults by working towards their meaningful goals. During the programme, the person's physical and social environment will be put to optimal use, and sufficient support will be provided to informal caregivers to reduce their burden. Lastly, the programme aims for continuity of care and better communication and coordination. CONCLUSION The I-MANAGE programme can be tailored to the local practices and resources and is therefore suitable for the use in different settings, nationally and internationally. If the programme is implemented as described, it is important to closely monitor the process and results.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Guadaña J, Oyeneyin B, Moe CF, Tuntland H. Publication Trends in Reablement - A Scoping Review. J Multidiscip Healthc 2023; 16:1641-1660. [PMID: 37333025 PMCID: PMC10276570 DOI: 10.2147/jmdh.s407802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background Reablement is a holistic and multidisciplinary intervention that can facilitate achievement of service users' goals related to their independence in everyday activities. Reablement has been the subject of increasing scientific activity in recent years. Currently, no review has provided a broad overview of the extent and breadth of international publications in reablement. Objective The objectives were 1) to map the volume of reablement publications, how the publications had increased over time, and their geographical distribution, 2) to identify the publication types and designs, 3) to identify publication trends, and 4) to identify knowledge gaps in the current peer-reviewed literature. Methods The scoping review approach designed by Arksey and O'Malley was used to identify peer-reviewed articles on reablement. Information was obtained on scientific activity on reablement over a period of more than two decades from five electronic databases and without language restrictions. Data was extracted from the eligible articles and both descriptive analysis and thematic analysis of the data was performed. Results A total of 198 articles published from 1999 to August 2022 from 14 countries were identified. There is a continuous interest in the field from countries where reablement has been implemented. An international and historical overview among countries with peer-reviewed publications on reablement is presented, which also partly reflects the countries that have implemented reablement. Most of the research derives from Western countries, in particular from Norway. Varied approaches to publications in reablement were noted with the majority being empirical and quantitative in nature. Conclusion The scoping review confirms the continued expansion of the breadth of reablement-focused publications in terms of originating countries, target populations, and research designs. In addition, the scoping review contributes to the knowledge base regarding reablement's research front.
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Affiliation(s)
- Jean Guadaña
- Department for Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Babatunde Oyeneyin
- Victoria Ward, Farnham Road Hospital, Surrey and Borders Partnership NHS Foundation Trust, Guildford, UK
| | | | - Hanne Tuntland
- Department for Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Mjøsund HL, Uhrenfeldt L, Burton E, Moe CF. Promotion of physical activity in older adults: facilitators and barriers experienced by healthcare personnel in the context of reablement. BMC Health Serv Res 2022; 22:956. [PMID: 35897061 PMCID: PMC9327260 DOI: 10.1186/s12913-022-08247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being physically active is important for maintaining function and independence in older age. However, there is insufficient knowledge about how to successfully promote physical activity (PA) among home-dwelling older adults with functional challenges in real-life healthcare settings. Reablement is an interdisciplinary, person-centered approach to restoring function and independence among older adults receiving home care services; it also may be an opportunity to promote PA. However, reablement occurs in many different contexts that influence how PA can be integrated within reablement. This study aimed to identify facilitators and barriers experienced by healthcare professionals (HCPs) that influence the promotion of PA within the context of reablement. METHODS This exploratory qualitative study is guided by a realist perspective and analyzed through inductive content analysis. Sixteen HCPs, including occupational therapists, physical therapists, registered nurses, and home care workers, participated in semi-structured interviews. The HCPs were recruited from four Norwegian municipalities with diverse sizes and different organizational models of reablement. RESULTS The HCPs experienced several facilitators and barriers at the participant, professional, organizational, and system levels that influenced how they promoted PA through reablement. Factors related to the individual person and their goals were considered key to how the HCPs promoted PA. However, there were substantial differences among reablement settings regarding the degree to which facilitators and barriers at other levels influenced how HCPs targeted individual factors. These facilitators and barriers influenced how the HCPs reached out to people who could benefit from being more physically active; targeted individual needs, desires and progression; and promoted continued PA habits after reablement. CONCLUSIONS These findings exemplify the complexity of facilitators and barriers that influence the promotion of PA within the reablement context. These factors are important to identify and consider to develop and organize healthcare services that facilitate older adults to be active. We recommend that future practice and research in reablement acknowledge the variations between settings and consider mechanisms on a participant and professional level and within an integrated care perspective.
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Affiliation(s)
- Hanne Leirbekk Mjøsund
- Faculty of Nursing and Health Sciences, Nord University, Universitetsallèen 11, 8026, Bodø, Norway.
| | - Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Sciences, Nord University, Universitetsallèen 11, 8026, Bodø, Norway
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia.,enAble Institute, Curtin University, Perth, Australia
| | - Cathrine Fredriksen Moe
- Faculty of Nursing and Health Sciences, Nord University, Universitetsallèen 11, 8026, Bodø, Norway
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Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review. Eur J Ageing 2022; 19:903-929. [PMID: 36692753 PMCID: PMC9729664 DOI: 10.1007/s10433-022-00693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Abstract
This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were searched. Articles were included when published between 2002 and 2020, which described a Randomised or Clinical Controlled Trial of a reablement intervention matching the criteria of the ReAble definition, and had ADL functioning as an outcome. Snowball sampling and expert completion were used to detect additional publications. Two researchers screened and extracted the identified articles and assessed methodological quality; discrepancies were resolved by discussion and arbitration by a third researcher. Twenty relevant studies from eight countries were included. Ten of these studies were effective in improving ADL functioning. Identifying promising features was challenging as an equal amount of effective and non-effective interventions were included, content descriptions were often lacking, and study quality was moderate to low. However, there are indications that the use of more diverse interdisciplinary teams, a standardised assessment and goal-setting method and four or more intervention components (i.e. ADL-training, physical and/or functional exercise, education, management of functional disorders) can improve daily functioning. No conclusions could be drawn concerning the effectiveness on ADL functioning. The common elements identified can provide guidance when developing reablement programmes. Intervention protocols and process evaluations should be published more often using reporting guidelines. Collecting additional data from reablement experts could help to unpack the black box of reablement.
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Burton E, Horgan NF, Cummins V, Warters A, Swan L, O’Sullivan M, Skelton DA, Townley B, Doyle F, Jabakhanji SB, Sorensen J, Rooney D, Murphy L, Galvin R. A Qualitative Study of Older Adults’ Experiences of Embedding Physical Activity Within Their Home Care Services in Ireland. J Multidiscip Healthc 2022; 15:1163-1173. [PMID: 35615293 PMCID: PMC9126230 DOI: 10.2147/jmdh.s351714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
- Correspondence: Elissa Burton, Curtin School of Allied Health, Curtin University, GPO Box U1987, Bentley, Western Australia, 6845, Australia, Tel +61 8 9266 4926, Fax +61 8 9266 3699, Email
| | - N Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vanda Cummins
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Lauren Swan
- North Dublin Home Care (NDHC), Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
- Later Life Training Ltd, Killin, Scotland
| | | | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira B Jabakhanji
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Lisa Murphy
- North Dublin Home Care (NDHC), Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick (UL), Limerick, Ireland
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Lewis LK, Henwood T, Boylan J, Hunter S, Lange B, Lawless M, Milte R, Petersen J. Re-thinking reablement strategies for older adults in residential aged care: a scoping review. BMC Geriatr 2021; 21:667. [PMID: 34847860 PMCID: PMC8638477 DOI: 10.1186/s12877-021-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
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Affiliation(s)
- Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Song CY, Lin PS, Hung PL. Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179374. [PMID: 34501963 PMCID: PMC8431322 DOI: 10.3390/ijerph18179374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical-cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.
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Affiliation(s)
- Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Correspondence:
| | - Pay-Shin Lin
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Master Degree Program in Healthcare Industry, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Pei-Lun Hung
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
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Rooijackers TH, Kempen GIJM, Zijlstra GAR, van Rossum E, Koster A, Lima Passos V, Metzelthin SF. Effectiveness of a reablement training program for homecare staff on older adults' sedentary behavior: A cluster randomized controlled trial. J Am Geriatr Soc 2021; 69:2566-2578. [PMID: 34097301 PMCID: PMC8518811 DOI: 10.1111/jgs.17286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND/OBJECTIVES Homecare staff often take over activities instead of "doing activities with" clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the "Stay Active at Home" (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. DESIGN Cluster randomized controlled trial (c-RCT). SETTING Dutch homecare (10 nursing teams comprising a total of 313 staff members). PARTICIPANTS 264 clients (aged ≥65 years). INTERVENTION SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. MEASUREMENTS Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. RESULTS We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes. CONCLUSION Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
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Affiliation(s)
- Teuni H. Rooijackers
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - Gertrudis I. J. M. Kempen
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - G. A. Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
- Research Center for Community Care, Academy of NursingZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Valéria Lima Passos
- Department of Methodology and Statistics, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
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Chiu EC, Chi FC, Chen PT. Investigation of the home-reablement program on rehabilitation outcomes for people with stroke: A pilot study. Medicine (Baltimore) 2021; 100:e26515. [PMID: 34190182 PMCID: PMC8257914 DOI: 10.1097/md.0000000000026515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Reablement is 1 approach to conduct rehabilitation in the community (ie, home environment), which aims to enhance an individual's functional ability to perform everyday activities that individuals perceive as important. We investigated the effects of a home-reablement program on different rehabilitation outcomes in people with stroke. METHODS A single-blind randomized clinical trial was conducted. Twenty-six people with stroke were randomly assigned to the home-reablement group or control group. For 6 weeks, participants in the home-reablement group received training for activities of daily living (ADL) that they perceived as important but difficult to perform. Participants in the control group received conventional rehabilitation in the hospital. Outcome measures included the Fugl-Meyer Assessment for the upper-extremity (FMA-UE) and the Stroke Impact Scale 3.0 (SIS 3.0) subscales. RESULTS No statistically significant differences between the 2 groups were noticed in the FMA-UE and the SIS 3.0 subscales (P = .226-1.000). Small effect size (success rate difference = 0.12-0.25) were noticed in the FMA-UE and the 5 SIS 3.0 subscales. The home-reablement group exhibited a greater proportion of participants with scores greater than the minimal detectable change in the FMA-UE and the 6 SIS 3.0 subscales (ie, strength, ADL/instrumental ADL, mobility, emotion, memory, and participation). CONCLUSIONS People with stroke that underwent the 6-week home-reablement program showed potential for improving their motor function, ADL/instrumental ADL, emotion, memory, and activity participation.
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Affiliation(s)
- En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Fang-Chi Chi
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Taipei City Long-Term Care Management Center, Taipei, Taiwan
| | - Pei-Tsen Chen
- Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
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Mjøsund HL, Moe CF, Burton E, Uhrenfeldt L. Promotion of Physical Activity Through Reablement for Older Adults: Exploring Healthcare Professionals' Clinical Reasoning. J Multidiscip Healthc 2021; 14:1623-1635. [PMID: 34234450 PMCID: PMC8254412 DOI: 10.2147/jmdh.s315553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Reablement is an interdisciplinary, multifactorial, and individualized intervention aimed at improving function and maintaining the independence of community-dwelling older adults who receive home care services. Physical activity (PA) is important for functional ability in older adults, but it is unclear how PA is promoted through reablement. Healthcare professionals' (HCPs) clinical reasoning and decision-making are essential and determine how reablement is delivered to individuals. Exploring how HCPs integrate PA into their clinical reasoning is critical to understanding how PA is integrated within reablement. To gain knowledge of how PA is integrated within reablement, there is a need to explore how HCPs integrate PA into their clinical reasoning. Purpose The study aimed to explore how PA is integrated into HCPs' clinical reasoning in a Norwegian reablement setting. Methods Sixteen HCPs, including occupational and physical therapists, registered nurses, and other home care staff, were recruited from four Norwegian municipalities. They participated in semi-structured interviews that were transcribed verbatim, and an interpretive content analysis approach was used. Results PA was integrated into multifaceted clinical reasoning captured by the main theme: "Improving the person's ability to participate in meaningful activities." Within this overall theme, two sub-themes emerged with a primary focus on either i) increasing physical capacity or ii) improving activity performance. Each subtheme encompassed different aspects of clinical reasoning and diverse perspectives on how to integrate PA in reablement. Conclusion HCPs' decision-making in reablement builds upon complex clinical reasoning and incorporates diverse perspectives on integrating PA in the delivery of reablement. This broad approach may be useful in targeting different needs, preferences, and contexts. There is a need to further investigate how PA is appropriately promoted through reablement, how it meets the needs and preferences of participants, and which contextual factors influence PA promotion through reablement.
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Affiliation(s)
| | - Cathrine Fredriksen Moe
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Vestøl I, Debesay J, Bergland A. The journey of recovery after hip-facture surgery: older people's experiences of recovery through rehabilitation services involving physical activity. Disabil Rehabil 2021; 44:5468-5478. [PMID: 34121569 DOI: 10.1080/09638288.2021.1936659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: This study sought to explore and describe the experiences of recovery among community-living older people undergoing rehabilitation involving physical activity following hip-fracture surgery. Methods: We conducted in-depth interviews with 5 men and 16 women (age range: 67 - 84 years). The data were analysed by means of systematic text condensation.Results: The analysis revealed the following four interrelated themes: (1) what participants bring to the recovery situation matters; (2) support through individually tailored rehabilitation services, involving physical activity, - is key to recovery following hip fracture surgery; (3) needing professional help on the journey from helplessness and vulnerability to being more confident and active; and (4) making progress and regaining function represent the essence of recovery.Conclusions: All four identified themes relate to how physical activity, as an aspect of rehabilitation services, contributes to the recovery process for patients who have experienced a hip fracture. Differences were reported with regard to the services used, and all the participants were at the mercy of what their municipalities chose to offer in terms of rehabilitation services.IMPLICATIONS FOR REHABILITATIONMunicipal healthcare services should address patients' individual needs when planning, organising and implementing rehabilitation programmes involving physical activity.Healthcare professionals need to recognise older patients' experiences of reduced physical, psychological and social functioning following hip-fracture surgery and then take those experiences into account when tailoring rehabilitation programmes.Healthcare professionals providing physical rehabilitation programmes to people who have undergone hip-fracture surgery should take into account their patients' situation and lifestyle prior to experiencing a hip fracture.Municipal healthcare services should consider using recovery as a conceptual framework in relation to rehabilitation services involving physical activity.
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Affiliation(s)
- Irene Vestøl
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Baldelli G, De Santi M, De Felice F, Brandi G. Physical activity interventions to improve the quality of life of older adults living in residential care facilities: a systematic review. Geriatr Nurs 2021; 42:806-815. [PMID: 34090224 DOI: 10.1016/j.gerinurse.2021.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Pursuing active aging and maintaining the quality of life (QoL) is essential, particularly in older people living in residential care facilities (RCFs). We evaluated physical activity (PA) as an intervention to improve the QoL in this population, trying to hypothesize future perspectives in this field. METHODS A systematic search was performed on Pubmed. Only randomized control trials or quasi-experimental control group trials were considered. RESULTS Results showed that a high-frequency PA can be effective in older people, allowing them to improve their functional mobility, autonomy, anxiety level, balance, and social interactions. Moreover, a moderate-intensity PA showed the most interesting results, improving all the QoL-related aspects considered. CONCLUSION Results highlight the beneficial effects of multidisciplinary intervention strategies in increasing QoL and QoL-related aspects of RCFs older residents, contemplating PA as the main instrument. However, structured PA is necessary to fully understand which protocol could be the most effective.
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Affiliation(s)
- Giulia Baldelli
- Biomolecular Sciences Department, Public Health Unit, University of Urbino Carlo Bo, Urbino, Italy.
| | - Mauro De Santi
- Biomolecular Sciences Department, Public Health Unit, University of Urbino Carlo Bo, Urbino, Italy
| | | | - Giorgio Brandi
- Biomolecular Sciences Department, Public Health Unit, University of Urbino Carlo Bo, Urbino, Italy
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