Clare, Linda

de Vugt, Marjolein

Graff, Maud

Jeon, Yun-Hee

Kristensen, Hanne Kaae

Low, Lee-Fay

Metzelthin, Silke

Pool, Jackie

Poulos, Christopher

Rahja, Miia

Rosendahl, Erik

Thuesen, Jette

Tuntland, Hanne

Zingmark, Magnus

English

Syddansk Universitets Forskerportal

       University of Southern DenmarkReablement meeting the challenges facing dementia servicesMetzelthin, Silke; Thuesen, Jette; Tuntland, Hanne; Zingmark, Magnus ; Jeon, Yun-Hee ;Kristensen, Hanne Kaae; Low, Lee-Fay ; Poulos, Christopher; Pool, Jackie; Rahja, Miia;Rosendahl, Erik; de Vugt, Marjolein; Clare, Linda; Graff, MaudPublication date:2024Document version:Accepted manuscriptDocument license:UnspecifiedCitation for pulished version (APA):Metzelthin, S., Thuesen, J., Tuntland, H., Zingmark, M., Jeon, Y.-H., Kristensen, H. K., Low, L.-F., Poulos, C.,Pool, J., Rahja, M., Rosendahl, E., de Vugt, M., Clare, L., & Graff, M. (2024, Dec 1). Reablement meeting thechallenges facing dementia services.Go to publication entry in University of Southern Denmark's Research PortalTerms of useThis work is brought to you by the University of Southern Denmark.Unless otherwise specified it has been shared according to the terms for self-archiving.If no other license is stated, these terms apply:            • You may download this work for personal use only.            • You may not further distribute the material or use it for any profit-making activity or commercial gain            • You may freely distribute the URL identifying this open access versionIf you believe that this document breaches copyright please contact us providing details and we will investigate your claim.Please direct all enquiries to puresupport@bib.sdu.dkDownload date: 25. Oct. 2025Policy BriefDecember 2024Reablement: meeting the challenges facing dementia servicesDementia is a major cause of disability. People with dementia need good support, but health and social care services are overstretched and cannot provide all the support people need. Progress with drug treatments and preventive measures will not be enough to solve the problem. We need effective non-pharmacological approaches to reduce disability for people with dementia. Reablement, or rehabilitation, is one such approach.1Reablement enables people to maintain or regain abilities, stay involved with activities that are important to them, continue participating in society, and experience a meaningful life. It is a sustainable, low-cost way of managing disability and reducing its impact.2 People with dementia can benefit from reablement at all stages of severity. Yet reablement is not widely implemented in dementia services. To make this happen, three key changes are needed: I have become more independent and will now go out on my own regularly. I have attempted volunteering in a charity shop and will now get shopping on my own. person with dementiaIn a Dutch trial, staff trained in reablement enabled their clients to participate in daily activities to a greater extent than staff who were not trained. This effect was seen after 6 months and maintained 3 months later.iThe policy challengePeople are living longer but many spend a significant proportion of their later lives in ill-health. Dementia is one of the main causes of disability. It affects the ability to function in daily life, engage in meaningful activity, and participate in society. More than 55 million people worldwide live with one of many neurodegenerative conditions resulting in dementia. Nearly 10 million people are newly diagnosed each year. Health and social care services are ill-equipped to cope, and as populations age, fewer younger people are available to provide care. We need effective, sustainable ways of reducing disability for people living with dementia and supporting their families3 4. The World Health Organization has recognised the global relevance of rehabilitative interventions by producing a Package of Rehabilitation Interventions for Dementia5. Reablement is a rehabilitative approach1 that can be implemented at scale.Goal attainment by people with dementia was maintained six months after the end of the intervention in a UK trial.iWhat needs to happen?•  A shift in attitudes We need to think about what people can do and wish to do, with the right support, and not just about what they cannot do. This way of thinking supports autonomy, dignity and inclusion across all stages of progression and environments. People affected by dementia, practitioners and the public need to know that reablement can promote functioning and reduce disability.•  A change in how services work Health and social care services often focus on disability, carrying out tasks for people or providing assistance with tasks. Reablement is different. It emphasizes people’s abilities and priorities. Services are personalized and flexible and delivered by an interdisciplinary team.•  A focus on building capacity To make reablement a reality, we need a workforce equipped with the right skills and the right organizational contexts. To ensure reablement is as effective as possible, we need to keep extending the evidence base through targeted research initiatives.What is reablement?Reablement1 2 builds on what people can do and what is important to them. It helps people to maintain their abilities or regain them after an episode of ill-health or hospitalisation. This is different to usual care. Typically, usual care focuses on what people cannot do and involves assisting people or simply doing things for them.Rehabilitative approaches like reablement are relevant across all stages of dementia and in both home and residential care environments. Other examples of rehabilitative approaches include cognitive rehabilitation, community occupational therapy, restorative care or function-focused care. The principles and components of reablement are put into practice through a range of interdisciplinary interventions and service models. In the I-HARP trial involving clients with mild dementia, the overall health-related costs over 12 months were substantially less for those participating in I-HARP compared to those receiving usual care, averaging AUD $7,098 less per person. This cost difference was primarily due to delayed/prevented care home admissions.iThe family carer said how beneficial it had been because you get a diagnosis, and then you’re led to believe there is absolutely nothing you can do other than expect a decline in that person. And for her, it was important that she could see that there were lots of things that her husband could still do and achieve. practitionerKey pointsPeople with dementia need and have a right to, reablement, as it: •  Consistently enables people with dementia to function better in daily life.•  May improve well-being for people with dementia and family carers.•  Is a low-cost, sustainable approach with potential to demonstrate cost-effectiveness.Ongoing research efforts should focus on:•  How to implement reablement in health and social care systems.•  How best to measure the impact of reablement.•  Examining the longer-term effects of reablement.How does reablement work? Reablement involves working on real-life goals that are meaningful and support the person’s autonomy. Goals could involve being able to do complex activities like preparing and cooking a meal or using public transport to visit friends or participate in social activities, or more basic activities like re-learning how to dress oneself. Goals are usually addressed by a combination of strategies. These may include:•  Re-learning the practical skills needed to carry out activities•  Simplifying tasks and developing ways of compensating for difficulties•  Using enhanced learning strategies to take in new information•  Offering assistive devices and home modifications•  Coaching family carers in problem-solvingThe choice of strategies is based on a detailed understanding of the person’s abilities and the difficulties and barriers that interfere with being able to do the activity. Chosen activities are broken down into steps and learned or re-learned by building up the necessary abilities one step at a time. Difficulties are tackled directly or worked around, or adaptations are made to physical and social environments. Reablement principles can be implemented in all care settings by creating an environment where people living with dementia are involved in purposeful activity and equipping staff to make this happen through coaching and managerial support. Is reablement effective?Reablement consistently results in better functioning in the targeted areas.1 People make progress with, and achieve, their goals. These benefits appear to last. Goal attainment is some times accompanied by improvements in activities of daily living more generally, or quality of life.  Family carers consistently say they feel better equipped to cope with the consequences of dementia.1 This is often accompanied by reduced feelings of burden and better quality of life.Is reablement expensive?Reablement interventions are relatively inexpensive.1 Involving aides under the supervision of qualified staff helps to keep costs down. Reablement does not necessarily require expensive equipment or facilities.Is reablement cost-effective?Several reablement interventions and service models, although not all, have demonstrated cost-effectiveness.1RecommendationsWe recommend that:•  Reablement is included in national, regional and local dementia strategies as part of post-diagnostic support services, with sufficient resources and infrastructure allocated to it.•  Health and social care staff at each skill level, and managers, are trained in the principles and practice of reablement for people with dementia.•  Public awareness campaigns are conducted to increase understanding of the benefits of reablement.•  Research funders provide ringfenced funding opportunities to address evidence gaps in reablement research in dementia.It helped my husband to believe that he could have some control over his memory loss. It gave him a focus and a chance to try and retain some control and skills, and to maintain some independence.family carer1  Metzelthin SF, Thuesen J, Tuntland H, Zingmark M, Jeon YH, Kristensen HK, Low LF, Poulos CJ, Pool J, Rahja M, Rosendahl E, de Vugt ME, Giebel C, Graff MJ, Clare L. Embracing Reablement as an Essential Support Approach for Dementia Care in the 21st Century: A Position Paper. J Multidiscip Healthc. 2024;17:5583-5591. https://doi.org/10.2147/JMDH.S4840692  Metzelthin SF, Rostgaard T, Parsons M, Burton E. Development of an internationally accepted definition of reablement: a Delphi study. Ageing and Society. 2022;42(3):703-718. doi:10.1017/S0144686X200009993  World Health Organization. Global Action Plan on the Public Health Response to Dementia 2017–2025. Geneva: WHO, 2017. https://iris.who.int/bitstream/handle/10665/259615/?sequence=1 4  Alzheimer’s Disease International. From Plan to Impact VII. London: ADI, 20245  World Health Organization. Package of Interventions for Rehabilitation. Module 3. Neurological Conditions. Geneva: WHO, 2023ReferencesAuthors Metzelthin SF  Maastricht University / Living Lab in Ageing and Long-Term Care Thuesen J  REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care / University of Southern Denmark Tuntland H  Western Norway University of Applied Sciences Zingmark M  Umeå University Jeon Y-H  University of Sydney Kristensen H  University of Southern Denmark Low L-F  University of Sydney Poulos CJ  UNSW/ HammondCare Pool J  Dementia PAL Rahja M  Flinders University Rosendahl E  Umeå University Vugt M  Alzheimer Center Limburg / Maastricht University Graff MJL  Radboudumc Alzheimer Center, Radboud University Medical Center Nijmegen Clare L  University of ExeterBURO BONNÉ | 1451Cognitive rehabilitation for people with dementia delayed care home admission by 6 months on ave-rage in a French study.iHealthcare costs from a societal perspective were nearly 600 euro less over a six-month period for nursing home residents who received reablement than for those who did not in a Dutch trial. iEnquiriesFor enquiries, please contact:Dr Silke Metzelthins.metzelthin@maastrichtuniversity.nlFunding statementThis work was supported by the EU Joint Programme - Neurodegenerative Disease Research (JPND) / The Netherlands Organisation for Health Research and Development (ZonMw)

Reablement meeting the challenges facing dementia services

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Reablement meeting the challenges facing dementia services

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