Reablement through time and space: A scoping review of how the concept of ‘reablement’ for older people has been defined and operationalised

Abstract

Abstract Background: While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have been struggling 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 a great deal of confusion, ambiguity, and disagreement has arisen regarding the terminology and the structure of these programmes, and they may not be adequately supporting older people. Could a clarification of the concept help reablement become more effective in theory and in practice?Methods: We 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 1947–2019, 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.Results: The fundamental principles of reablement have a long history. However, these programmes have undergone a widespread expansion since the early 2000s with an intention to reduce costs related to providing long-term care services and in-home assistance to growing older populations. As reablement programmes have developed internationally, they have begun to overemphasise training older people to (re)gain their skills and confidence in maintaining or improving functional ability related to activities of daily living (ADLs). Conclusions: Reablement programmes are fundamentally intended to be person-centred and should support older people in attaining their self-defined goals to be both more physically independent at home and socially involved in their communities. However, the rapid implemention of these programmes without clear evidence for the full scope of their potential effects and impact means that they may not adequately consider older people’s own goals. A continued lack of agreement about what reablement is (and what it should achieve) may lead to ineffective programmes and unclear guidance on which outcomes to measure.