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

Abstract

Background: 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. 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?

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 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.

Results: The 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.

Conclusions: Reablement 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.

Keywords: Activities of daily living; Ageing; Health services; Homecare; Literature review; Reablement; Rehabilitation; Restorative care.

Fig. 1

Flow Chart of Article Selection. This flow chart describes the selection process from articles identified (N=120) to final eligible articles for analysis (N=86)

Fig. 2

Term Map Visualisation from Abstracts of All 86 Final Eligible Abstracts. We created a term map showing the most relevant terms from the abstracts of all 86 final eligible articles. Out of 2238 terms, 220 met the threshold of five occurrences. Here, we visualised 60% of the most relevant terms, which amounted to 132 terms with 3315 links between the terms. Each circle represents a term from the various abstracts, and the lines connecting the circles represent the interrelatedness of different terms. The size of the circle represents the number of occurrences of the term. The closer the circles are to each other indicates a high co-occurrence of terms representing a topic. The term map is coloured according to publication year, with dark blue/purple circles indicating terms from the earliest publication in 1947 until 2012 transitioning to teal in year 2013–2014, then turquoise/green in 2015–2017, and thereafter yellow indicating terms from the most recent publications in year 2018–2019