Q&A with Australian researcher, Dr. Claire O’Connor.

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‘Reablement’ refers to maintaining or improving a person’s function and may ultimately lead to improved quality of life. The goals of reablement are set by each individual person. A person’s goal might be to engage in everyday activities, be physically mobile and/or be able do things they love and value for as long as possible.

Dementia Connections reached out to leading reablement researcher, Dr. Claire O'Connor to learn more about reablement as a new approach to maximize independence and quality of life for people living with dementia.

Reablement involves individualized goal setting and personalized program planning to address identified goals, therefore, it is a person-centred approach to care.

– Dr. Claire O'Connor

What is reablement? How is it different than person-centered care?

Reablement in dementia is about maximizing a person’s functioning through maintaining abilities, regaining functioning where possible or adapting to changes that have resulted from dementia. Through this, reablement has potential to improve independence, quality of life, and extend time living at home for people with dementia.

Reablement involves individualized goal setting and personalized program planning to address identified goals, therefore, it is a person-centred approach to care. The approach to reablement should specifically address the wants, values, functional abilities, support network and environment of each individual.

Reablement goals vary widely as they are individualized. For example, one person may have a desire to continue cooking the evening meal, while another may wish to continue accessing their local gym to exercise, and another may wish to continue with their weekly social coffee group. Depending on the identified goals, a range of allied health disciplines may be involved in supporting each individual in achieving their goals, e.g. occupational therapy, physiotherapy, exercise physiology, speech therapy etc.

What are the foundational principles of reablement?

Reablement programs should:

  • Be person-centred
  • Holistic (i.e. accounting for the various needs and abilities of the person)
  • Involve personally meaningful, individualized goal setting
  • Be time-limited (i.e. long and intensive enough to achieve goals, while balancing program cost)
  • Involve a range of allied health input, depending on each individual goal

I think that the brain and the body work together in harmony, and reablement can help build new brain pathways and help you stay well for longer.

– Theresa Flavin, Person living with dementia and HammondCare Dementia Centre Lived Experience Associate Consultant

How does reablement support people living with dementia who are experiencing progressive decline?

Reablement provides an opportunity to establish what a person’s strengths are, and to build upon these to maintain functioning in these areas for as long as possible, or even improve functional ability in some areas. For example, if a person with dementia was to be supported in a regular exercise routine tailored to their specific abilities and goals, they could improve their physical functioning, which could have flow-on effects in other areas, such as reducing their risk for falls.

How does reablement differ from rehabilitation programs, physiotherapy or occupational therapy? 

Reablement and rehabilitation in the context of dementia are similar concepts. Both of these concepts are focused around maximizing functioning, involving a team-based approach to care with a range of allied health disciplines, and achieving personalized, meaningful goals.

Physiotherapy and occupational therapy are important disciplines that contribute to reablement programs. For example, a person who wished to continue gardening, may have input from a physiotherapist to ensure enough strength and balance to bend and walk around the garden, and input from an occupational therapist to learn strategies to safely and effectively continue with gardening, such as using raised garden beds, and a retractable hose so as not to trip over the hose.

Reablement Guides

Are reablement plans different for people with dementia living in community than for people who live in care homes?

As reablement is a person-centred and inclusive approach to care, each person who accesses a reablement program should have a tailored, personalized program based on their own individual goals, abilities, and context. Therefore, reablement plans will differ for each person, whether they are living in the community or living in residential care. The benefit of this personalized approach is that reablement programs can be flexible to fit within each person’s context and support each person according to their own specific abilities, needs and wants.

How is reablement being spread into practice around the world?

Understanding around the term reablement varies over the world; a recent international survey to define the term ‘reablement’ still only obtained 79% agreement. In Australia, the terms ‘rehabilitation’ and ‘reablement’ are both being used to describe similar concepts in the context of dementia.

Despite this lack of agreement around terminology, rehabilitation (and reablement) are essential for optimal care of people with dementia to maximize functioning and independence. The recently released WHO Package of interventions for rehabilitation for dementia highlighted the importance of equitable access to rehabilitation (and therefore, reablement) for all people living with dementia.

Unfortunately, uptake of this recommendation in practice has been slow, and access to these services remains limited for many people living with dementia around the world. In Australia, my team is currently working to understand how we can overcome the barriers to making reablement available and accessible for people living with dementia. We hope that ultimately, these services will be made available for all people living with dementia as part of routine care.

GET MORE INFORMATION

For those interested in learning more about reablement for people living with dementia, Dr. O'Connor and her team have developed a series of freely available resources for download: www.hammond.com.au/reablement

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ABOUT THE AUTHOR

Claire O'Connor is a Senior Research Fellow in the School of Psychology, University of New South Wales, Australia, an Honorary Senior Research Fellow with Neuroscience Research Australia and HammondCare, and is also a registered occupational therapist (AHPRA).

Claire is currently undertaking a Dementia Centre for Research Collaboration (DCRC) post-doctoral fellowship to understand how to bridge the implementation gap to maximize everyday functioning for people living with dementia through evidence-informed reablement and rehabilitation.

Combining her clinical training in occupational therapy and research skills, Claire is passionate about contributing to research that is meaningful to ageing populations and people impacted by dementia.

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