A systematic review and meta-analysis of reablement interventions for people in permanent residential aged care homes

Interprofessional homebased reablement intervention for older adults in Sweden: a randomized controlled trial

BACKGROUND

Reablement has a health promotive perspective. The goal is to enhance or maintain health and functional ability and, thereby, the ability of older adults to live in their own homes. The intervention described in this study was introduced so the older person would remain at home and be given the opportunity to regain or maintain functional ability physically, mentally, and socially to live independently and have optimal health and well-being. This paper aims to report the measured effects of reablement among the older adults in terms of bio-psycho-social health that emerged in the randomized controlled trial (RCT).

METHODS

A sample of older adults (65+) was studied, consisting of those who applied for homecare in the municipal home service (n = 237), those who received intensive home reablement (IHR) carried out by an interprofessional team, and a control group who received home-based care as usual. Data were collected at three different occasions with validated instruments: at inclusion, after completion of IHR, and 3 months after completed intervention.

RESULTS

Both groups improved significantly at the post-measurement, and this improvement was maintained at the 3-month follow-up regarding: global quality of life (HACT); general health (EQ-5D-5 L); the self-estimates for mobility, hygiene, daily activities, pain/discomfort, anxiety/depression (EQ-5D-5 L); subjective well-being (GP-CORE); self-assessed capacity to perform physical activities as well as satisfaction with performance (COPM); measures of physical activity capacity regarding lower extremities (SPPB); upper extremities (hand dynamometer test). No between group differences were statistically significant. At the 3-month follow-up, the average number of homecare hours was slightly lower in the group that underwent IHR than in the group receiving usual homecare and rehabilitation interventions, but the difference was not statistically certain.

CONCLUSIONS

In this RCT with a relatively short follow-up period, IHR was equivalent to traditional homecare regarding older people's self-reported health, physical activity ability and number of homecare hours.

TRIAL REGISTRATION

ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT03565614?intr=Reablement&rank=4) Registration number: NCT03565614. Registered on 1 January 2016.

The power of connectedness: Vital communities for people with long-term care needs

Vital communities (VCs) are becoming increasingly important in society due to the aging in place movement, with attention focussed on the community and informal network of older persons. However, there is no clear conceptualization of a VC, especially not when people with long-term care (LTC) needs are included. In the current situation, one often sees that older adults with care needs are excluded from the community. This study aims to conceptualize a VC, focusing on older people with LTC needs. An iterative multimethod approach was used. A hermeneutic review of the vitality and community literature, including LTC literature, was performed to identify the constructs that lead to a community and vitality. Two focus groups (n = 15 and n = 9) were conducted to discuss the framing of the literature into a framework. Seven building blocks were identified in a pyramid structure: the Vital Community Pyramid (VCP). At the "foundational level" of the VCP lies interaction, an essential prerequisite for developing and sustaining communities. The second level involves "activity building blocks," specifically active participation and reciprocity. These encompass actions undertaken by members for the mutual benefit of the community. The third level, the "community-creation level" consists of the desire to belong, a sense of community, and adherence to community norms. The building blocks within this level transform a group of individuals into a community. Finally, resilience crowns the pyramid in the fourth level called the "vital community level" and captures the community's ability to persist over time. A VC seems to be applicable to people who require LTC. The VCP can potentially guide initiators and other stakeholders involved in a VC and can contribute to the facilitation of including people with LTC needs in VCs. Future research should focus on the empirical evidence of VCs and their impact.

Rehabilitation, reablement, and restorative care approaches in the aged care sector: a scoping review of systematic reviews

BACKGROUND

Ageing populations are set to drive up demand for aged care services, placing strain on economies funding social care systems. Rehabilitation, reablement, and restorative care approaches are essential to this demographic shift as they aim to support independent function and quality of life of older people. Understanding the impact of these approaches requires nuanced insights into their definitions, funding, and delivery within the aged care context. This scoping review mapped and compared systematic review-level research on rehabilitation, reablement, and restorative care approaches within aged care with the aim of determining definitional clarity, key themes, and the professional groups delivering each approach.

METHODS

Nine databases were searched (2012 to September 2023) to identify English-language systematic reviews on aged care-based rehabilitation, reablement and/or restorative care. Two reviewers independently screened studies following predetermined eligibility criteria. Only reviews reporting quality appraisal findings were eligible. Data charting and synthesis followed the Arksey and O'Malley approach and are reported according to PRISMA-ScR guidelines.

RESULTS

Forty-one reviews met inclusion criteria. Most (68%) reported on rehabilitation in aged care, and eight (20%) combined the approaches. Only 14 reviews (34%) defined the approach they described. Reviews centred on services for older people in the home or community (n = 15), across a mix of settings including community, hospital, and residential care (n = 10). Ten distinct themes highlight the importance of multidisciplinary teams, allied health, risk of falls, hip fracture, reduced functional independence, and specific types of interventions including physical activity, technology, cognitive rehabilitation, goal setting, and transition care. Most reviews described the role of occupational therapists (n = 22), physiotherapists (n = 20) and nurses (n = 14) with wider support from the multidisciplinary team. The quality of primary studies within the reviews varied widely.

CONCLUSIONS

This scoping review summarises the evidence landscape for rehabilitation, reablement, and restorative care approaches in the context of aged care. Despite their role in enhancing independence and quality of life for older people, policy, funding, and terminology variation means the evidence lacks clarity. This fragmented evidence makes it challenging to argue the effectiveness of one approach over another for older people in receipt of aged care services.

CLINICAL TRIAL NUMBER

Not applicable.

Using FRAME to adapt an evidence-based dyadic intervention program for people living with dementia in residential aged care: A pilot feasibility study

INTRODUCTION

The purpose of this study was to examine the feasibility of adapting and translating an evidence-based occupational therapist-delivered program shown to be effective in the community to residential aged care (RAC). The program aims to improve quality of care and quality of life for people living with dementia and the wellbeing of the family care partner.

METHODS

This study took place in a not-for-profit RAC home in Adelaide, South Australia. Mixed methods, specifically questionnaires, activity logs, focus group, and one-on-one interviews were used to evaluate the feasibility of the program implementation. Staff working in the participating home, occupational therapists trained to deliver the program, and residents and their family carer partners were included. Quantitative data were analysed using proportions, means, and standard deviations. Qualitative data were analysed using a thematic approach.

CONSUMER AND COMMUNITY INVOLVEMENT

This study was conducted together with a consumer (person living with dementia) and a carer representative (family member of someone residing in RAC). These representatives provided input towards the study design, interpretation of study data, discussion of results, and recommendations for future consideration.

RESULTS

Small changes to the program improved feasibility and acceptability for delivery in RAC. While the care home staff required added support during implementation, the intervention therapists felt that the program could be delivered in this setting. Family care partners of residents with dementia felt that the program may be better suited if provided upon entry to RAC or in early stages of dementia.

CONCLUSION

Adapting a community-based dementia care program to RAC can be safe and feasible. Program adaptations are necessary for feasibility. Further adaptations and evaluations of associated outcomes (related to residents with dementia and their family care partners) are needed to assess the program effectiveness in larger scale.

PLAIN LANGUAGE SUMMARY

Spending quality time with family members in residential aged care is important. However, many struggle to know what to say or do when visiting a family member who lives with dementia. Programs that teach families about how to communicate with people living with dementia, how to support them to take part in important everyday living activities, or how to understand why changes in behaviours may occur have not been available in residential aged care. This paper describes how we adapted one such evidence-based program from community to residential aged care settings. We consulted with people living with dementia, carers, and families and found that the program could also be valuable in this care setting. Residential aged care staff described how the program is very different to what is usually available in residential aged care, but they were optimistic that with the right support, it could be a valuable way to support residents with dementia and their families. Family members of residents with dementia and therapists delivering the program felt that residents in early stages of living in residential aged care and/or early stages of dementia could benefit the most from these programs. We found that including family members in the intervention process can be useful and empowering for families and residents. Future work should also focus on involving other staff members caring for residents in the process. Communication between staff and families is the key for program delivery and success and treating each person as an individual.

Pharmacist interventions in Asian healthcare environments for older people: a systematic review and meta-analysis on hospitalization, mortality, and quality of life

BACKGROUND

Pharmaceutical interventions play a key role in the care of older people experiencing polypharmacy. Despite the rapid increase in the aging population in Asia, there is a lack of evidence regarding the effectiveness of pharmacist interventions on older adult's healthcare. This systematic review and meta-analysis assessed the effects of pharmacist interventions in Asian health care environments on hospitalization, mortality, and quality of life (QoL) among older people in Asia.

METHODS

A comprehensive search was conducted across 5 databases, encompassing studies published from inception through June 2023. Only studies involving pharmacist interventions for people aged 65 years or older, residing in Asian countries, were considered. Studies without evidence of pharmacist involvement or conducted outside of Asia were excluded. Data extraction was performed by two reviewers, one reviewer (I.K.) performed the initial extraction, and another reviewer (G.R.) verified the extracted data. Forest plots were generated using a random effects model to obtain risk ratios or pooled standardized mean differences (SMDs).

RESULTS

A total of 170 articles underwent thorough review, and ultimately, ten studies meeting the inclusion criteria were included in the meta-analyses. These studies encompassed diverse healthcare settings such as outpatient, inpatient, and nursing homes, with sample sizes ranging from 32 to 306 older people. Pharmacist interventions were found to significantly reduce hospitalization rates (n = 5, risk ratio = 0.57, 95% CI = 0.41-0.81) and mortality rates (n = 4, risk ratio = 0.57, 95% CI = 0.37-0.88) among older people. The analysis revealed less significant improvement in QoL in these patients than in those receiving usual care (n = 6, SMD = 0.36, P = 0.057).

CONCLUSIONS

These findings highlight the crucial role of pharmacists within healthcare teams in Asian countries. Pharmacist interventions have an impact on reducing hospitalization and mortality rates among the elderly people, underscoring the importance of optimizing patient outcomes in Asia.

Four-Step Co-Designing of the Reablement Strategies Targeting Sarcopenia (ReStart-S): An Exercise-Based Multicomponent Program for Older Adults Residing in Long-Term Care Settings

Background

The prevalence of sarcopenia is concerningly high in long-term care settings (LTCS); yet, no exercise programs specifically targeting older adults living in residential care are available.

Objective

The goal of the present study was to co-design and validate a program named Reablement Strategies targeting Sarcopenia (ReStart-S) for older long-term care residents.

Design

Cross-sectional study with an exploratory phase.

Settings

LTCS in Udupi, Karnataka, India.

Participants

Sarcopenic older adults diagnosed using Asian Working Group for Sarcopenia 2019 criteria.

Material and Methods

The program was designed using a four-step intervention mapping technique involving systematic progression after completing each step. The steps included 1) identifying the appropriate exercise-based intervention for sarcopenia, 2) determining objectives and expected outcomes, 3) seeking expert views through a Delphi consensus approach, and 4) assessing the feasibility of ReStart-S program among older adults living in LTCS.

Results

A comprehensive literature review appraised existing exercise programs for managing sarcopenia. A workshop held with six older adults and one caretaker, decided on morning exercise sessions, recommended 2-7 days/week. The results of the review and workshop were compiled for the Delphi process that had seven experts from 5 countries, achieving a 71% response rate after four rounds. In the last step, a pilot study on eight LTCS residents, two males and six females with a mean age of 78.3 ± 8.3 years, was conducted and the program was found to be feasible.

Conclusion

The ReStart-S program for managing sarcopenia among older adults residing in LTCS incorporates evidence from the literature and the engagement of older adults, caregivers, and experts, making it a contextually appropriate intervention. Our study also provides researchers and healthcare professionals insight into co-designing an intervention program for vulnerable older adults. Finally, the program evaluation indicates that a full-scale trial testing the efficacy of the ReStart-S program is feasible.