Reablement, reactivation, rehabilitation and restorative programs show some promise to support older adults receiving home care

Sims-Gould J, Tong C, Wallis-Mayer L, et al.  Reablement, reactivation, rehabilitation and restorative interventions with older adults in receipt of home care: A systematic review  Journal of the American Medical Directors Association. 2017; 18(8), 653-663.

Review question

• Do reablement, reactivation, rehabilitation and restorative (4R) programs improve the quality of life for older adults receiving home-care services?

Background

• Home care is a vital component of the preventive care required to allow older adults to live at home safely and comfortably.
• As populations age, the demand for home care is increasing. Fewer healthcare workers are serving a greater number of elderly clients, and this reactive approach is simply not sustainable. Reablement, reactivation, rehabilitation and restorative (4R) programs offer a solution by providing a holistic, evidence-based and economically sound approach to maintaining and improving functional capabilities of older adults.
• The reablement, reactivation, rehabilitation and restorative programs are delivered by a team of professionals who aim to maximize independence with interventions focused on rehabilitative exercises, home modifications, task redesign, education regarding self-care, falls prevention and nutrition.
• There is a need to identify effective home-care approaches by evaluating the quality of current services such as 4R programs that benefit the aging population.

How the review was done

• A detailed search of electronic databases was conducted to identify studies measuring the impact of 4R programs on community-dwelling older adults. There was no date restriction on the search.
• A total of 853 studies were identified in searches, and 15 were included in the review after assessments for eligibility.
• This review was funded by a grant from the Canadian Institutes of Health Research.

What the researchers found

• The 4R programs in this review focused on the well-being of older adults receiving care after being discharged from hospital, as well as on clients receiving care without a hospital stay. In general, the descriptions of interventions were limited. For example, most studies failed to include the type of staff training required to execute 4R programs.
• Nevertheless, the review identified that 4R programs effectively reduce the amount of time that older clients need ongoing home care, due to their functional improvements and fewer restrictions on activity as a result of the interventions. As a result, 4R programs were shown to be cost-effective as the number of emergency-room visits and unplanned hospital stays among this population were reduced.

Conclusion

• These 4R programs proved to be promising in supporting older adults receiving home care, in terms of clinical outcomes and cost-effectiveness. Of all of the outcomes assessed, the 4R programs had the greatest impact on the mobility of older adults.
• Further research is recommended to identify how 4R programs can be structured to optimize the rehabilitation of older adults in all settings, which will make the related research more generalizable.