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Encouraging self-confidence in the elderly
The term ‘reablement’ is often used as a synonym for rehabilitation. While both include some element of restoring physical function, reablement is broader in context and shorter in duration. It is about an individual learning or relearning the day-to-day skills needed to encourage self-confidence and support independence.
Reablement is usually time-limited (approximately six-eight weeks) and has a strong focus on psycho-social as well as physical well-being. It has a primary goal of enabling people to maximise their capacity to continue to live in their own home.
Australian researcher Professor Gill Lewin led one of the few global randomised controlled trials of this approach and published evidence of its long-term cost effectiveness. Yet Australia has been slower to embed this into aged care policy and practice. This is starting to change with aged care policy and procurement now actively advocating for a reablement approach for aged care services. I believe one of the real challenges to reablement being fully embraced in Australia stems from ageism.
How many times do we, as clinicians, assume someone is unable to 'manage’ because of assumptions made based on their age or medical condition? How often have we communicated that to our patients and indirectly affected their own views of their capabilities.
Since joining Silver Chain as its National Medical Director, I have learned that ageism is debilitating. Positive self-perceptions of ageing results in increased longevity of more than seven years, and I have challenged my own assumptions.
I have also learned that I am not being helpful when I tell patients that I am going to refer them to My Aged Care so they get an aged care package, and someone will clean their house for them and help them shower safely.
Instead, I now talk about how I can refer them so someone can come to their home, see how they are managing everyday tasks and work with them to help them maintain their independence. This might mean investigating rails to reduce the risk of falling in the shower, or exercises to help build up the strength in their legs to improve their mobility.
Silver Chain has been providing short term, reablement-focussed support to older people for the past 20 years and the results have been extraordinary. It should be general practice and part of all our programs and services.
Take for example the case of the man whose mobility, following his six-week hospital stay for bladder stone removal and flu, deteriorated. His goal was to return to his pre-admission level of mobility – that being 200m to the local bus stop using a stick, a seated rest for a few minutes, then the 200m return walk. The man also wanted to be able to water his pot plants which required him to carry a watering can while walking on grass.
Within four weeks of his reablement phase, this person had achieved his goal with the support of a home exercise program and weekly sessions with Allied Health and Therapy Services. He remained in the program and on discharge could walk three times the distance (ie 1200m) with no seated rest and no walking aid required. He is now enjoying being back in the garden.
Or the woman who lost her driver’s licence due to her declining vision and cognition and lacked the confidence to take the bus to meet her friends. As a result, she became socially isolated and depressed. Through the reablement program, she learned the bus routes, purchased a Smart Rider and practised catching a bus with the assistance of a support worker. At the end of the reablement phase, she was confident enough to travel independently and taught her friends to do the same.
We, as clinicians, can build confidence or destroy it; we can support our patients to build on their strengths, or reduce them. The aged care system is moving to encourage independence through reablement strategies before older people are referred for ongoing services. While My Aged Care has a long way to go before this is standard practice, as is the case in the UK and New Zealand, we can support its implementation through our own actions.
The evidence of better outcomes for older people and taxpayers is compelling; I hope you join me in encouraging this approach with your patients.
This clinical feature was published on Page 7 of the Medical Forum Magazine, November 2019 edition. References on request.