Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits.

Chen-Yi Song,Pei-Lun Hung,Pay-Shin Lin

doi:10.3390/ijerph18179374

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.

Highlights

The purpose of the present study was to develop and evaluate the effect of a communitybased intervention combining PCHER among rural community-dwelling older adults with mobility deficits compared with a control in relation to mobility, cognitive function, activities of daily living (ADL) function, physical function, and self-perceived activity performance and satisfaction with performance
The present study found that combining individualized reablement and group-based physical–cognitive training and health education had greater effects on lower extremity function, mobility, cognitive function, and ADL function, relative to a control, among rural community-dwelling older adults with mild to moderate mobility deficits
As functional abilities are essential indicators of reablement [1,3,5], our findings support the potential use of reablement in the context of community for improving the mobility and functional independence of community-dwelling older adults

Summary

Introduction

Reablement services are approaches for maintaining and improving the functional independence of older adults [1]. The intervention is targeted, focused on enhancing the performance of daily activities defined as important by the person, and takes place in the person’s home and local surroundings [2]. The aim is to enable people to age in place, be active and participate socially and in society [2]. Previous studies demonstrated some positive impacts of reablement on functional abilities, health-related quality of life, and reduction in healthcare service utilization [3,4,5]. For older adults with mild disability, reablement was found to enhance independence from long-term care services [6].

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