Abstract
BackgroundWhile the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have struggled to reach consensus about how the newer offer of ‘reablement’ should be organised, operationalised, and understood as a health service for older adults. International research indicates that there is confusion, ambiguity, and disagreement about the terminology and the structure of these programmes, and they may not be adequately supporting older people’s self-identified goals. Could an analysis of the concept’s genealogy illuminate how reablement can be more effective and beneficial in theory and in practice?MethodsWe conducted a qualitative and quantitative scoping review to determine how reablement has developed through time and space. Eligible articles (N=86) had to focus on any of the defined features of current reablement programmes; there were no restrictions on study designs or publication dates. In articles published from 1947 to 2019, we identified themes and patterns, commonalities, and differences in how various countries described and defined reablement. We also performed an analysis using computer software to construct and visualise term maps based on significant words extracted from the article abstracts.ResultsThe fundamental principles of reablement have a long history. However, these programmes have undergone a widespread expansion since the mid-2000s with an intention to reduce costs related to providing long-term care services and in-home assistance to growing older populations. Despite theoretical aspirations to offer person-centred and goal-directed reablement, few countries have been able to implement programmes that adequately promote older people’s goals, social involvement, or participation in their local community in a safe, culturally sensitive and adaptable way.ConclusionsReablement is meant to support older people in attaining their self-defined goals to be both more physically independent at home and socially involved in their communities. However, until legislators, health professionals, and older people can collectively reach consensus about how person-centred reablement can be more effectively implemented and supported in professional home-care practice, it will be difficult to determine a conceptual description of reablement as a service that is unique, separate, and distinct from standard rehabilitation.
Highlights
While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have struggled to reach consensus about how the newer offer of ‘reablement’ should be organised, operationalised, and understood as a health service for older adults
With an emphasis on the older individual’s continuing ability to participate in, contribute to and be productive and valued in society, reablement programmes for older people could be an opportunity for governments to promote a more inclusive and balanced discourse about ‘healthy ageing’
Rather than attempting to carefully and methodically implement the first contemporary restorative-care model from 2002, reablement programmes have been rapidly implemented since the mid-2000s to reduce costs in the eldercare sector without clear evidence for the full scope of their potential effects and outcomes; our review indicates that the longterm efficacy of reablement initiatives still remains weak and inconsistent
Summary
While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have struggled to reach consensus about how the newer offer of ‘reablement’ should be organised, operationalised, and understood as a health service for older adults. Population ageing raises significant questions about the socio-economic sustainability of increased human longevity, and this demographic shift has resulted in the promotion of ‘healthy ageing’ in many Western societies. While there is no universally accepted definition for ‘healthy ageing’ – or active, productive, or successful ageing – such concepts typically refer to individual or collective strategies used to optimise economic, social, and cultural participation throughout the life course [1]. The paradigm of ‘healthy ageing’ is often emphasised in legislation and social policies that target older people [2,3,4,5], in high-income, industrialised Western societies that tend to valorise individualism and productivity. It supports the individual to remain socially engaged within the community context in a safe, culturally sensitive and adaptable way” [6]
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