Reablement and older people
The World Health Organization (WHO) outlines a model of healthy ageing in its 2015 World Report on Ageing and Health i that consists of two primary factors: an individual’s intrinsic capacity, and functional ability.
The evidence-based model suggests that even if an individual’s intrinsic capacity is diminished, the person may still be able to do the things that matter to them if they live in a supportive, enabling environment.
This reflects the concept of maximizing functional ability, which according to the WHO is the ultimate goal of healthy ageing.
Furthermore, the WHO approach suggests that it is the interplay of an individual’s intrinsic capacity with the environment that maximizes the opportunity for healthy ageing. As a person’s intrinsic capacity changes with age, the environment is an increasingly important factor in the domain of function of the older adult.
In this context, the environment may include policies that affect health, service delivery models, and new approaches to health and social care.
This model of healthy ageing accords with a move within international social policy towards envisioning what is being called ‘the enabling society’.
The enabling society will seek to harness new technology and new approaches to deliver programs and services that are more individualized, flexible and focused on long-term outcomes over a person’s life… in a way that provides more efficient program delivery and more effective collaboration between governments and other stakeholders.
The reablement approach for people with compromised functional capacity in everyday life, as its name implies, is one of enablement, and is therefore very much in tune with contemporary thought around bringing changes to the way in which health and social care is delivered in the community. Based on a bio-psycho-social model, reablement supports and encourages people to gain or restore autonomy in their own space, helping them to live well in their community, with a longer-term goal of reducing their need for supportive care. In short, the goal of reablement is to “enable people to be and to do what they have reason to value”.
While the reablement approach or model can usefully be employed with people of all ages who have reduced functional capacity, the focus of this report is on older people. Along the continuum of service provision,
the functional capacity of older people, for example with advanced dementia, complications of diabetes, and frailty can be expected to span a spectrum from high-level clinical care to assistive living and, when symptoms are milder, to services in the home, including reablement interventions.
The report offers a synthesis of the discussion papers generated at the International Federation on Ageing (IFA) Global Think Tank (October 2015) by four working groups comprising medical specialists, scientists and researchers in their respective fields of expertise — dementia and other neurodegenerative diseases, diabetes, frailty, and technology. These international experts were brought together by the IFA and DaneAge to consider the evidence to date for the potential of the reablement model to maintain and / or improve the functional capacity of older people, to the degree that may require fewer or different services; and may even reduce the premature admission of older people to a range of institutional care. The report summarizes the fruits of these discussions in relation to perceived benefits and challenges in a reablement approach, and presents recommendations for the future.