Evaluation of a wellness and reablement approach in Australia: Learnings from a pilot project

Abstract

Australian health and aged care reforms mandate a wellness and reablement (W&R) approach with services and the workforce needing to adjust their way of working with older people, to actively promote independence and participation in life's activities. Studies exploring the older person's perspective are sparse. This study aims to understand the older person's experience of a W&R approach, supplemented with experiences of staff trained in the approach. The study evaluates a W&R approach implemented across three community-based sites of a large Australian aged care provider. Staff from participating sites underwent training and were asked to use a W&R approach with at least one older person. Eighteen older people aged 65+ were engaged in the 4-month programme. Semi-structured interviews with older people and staff were conducted on completion of the programme. The W&R approach showed variable benefits and experiences of older people related to goal setting and outcomes. Overall, older people were unfamiliar with goal setting or displayed negative attitudes. Negative emotional responses to health decline and ageing, such as apathy, frustration, embarrassment and sense of helplessness, were identified as barriers to goal pursual. In contrast, enabling factors, such as assistive equipment, staff and social connection, triggered positive emotional responses, which acted as protective factors and enhanced goal pursual. Staff knowledge and understanding of the W&R approach also influenced older people's experience and outcomes. These findings recommend a stronger focus on the social and emotional aspects of W&R and codeveloping goals in line with the older person's sense of wellbeing. This approach supports the multiple dimensions of W&R and aligns with principles of positive and healthy ageing. Additional training for staff should be provided, with ongoing mentoring and support from W&R champions. Ensuring that goals are meaningful and valuable to individual older people will enhance successful goal pursual and improve outcomes.

Exploring the experience of reablement: A systematic review and qualitative evidence synthesis of older people's and carers' views

“…Five countries were represented across the 19 included articles: England (Beresford et al, 2019; Chung, 2019; Glendinning et al, 2010; Trappes‐Lomax & Hawton, 2012; Whitehead et al, 2018; Wilde & Glendinning, 2012), Norway (Bødker et al, 2019; Hjelle, Alvsvag, et al, 2017; Hjelle, Tuntland, et al, 2017; Jakobsen et al, 2019; Jokstad et al, 2020; Magne & Vik, 2020; Moe & Brinchmann, 2016), Scotland (Ghatorae, 2013; McLeod & Mair, 2009), Australia (Golenko et al, 2021; Jeon et al, 2019; Rahja et al, 2020) and Sweden (Östlund et al, 2019). The median date of publication across the studies was 2018 (range 2009–2021), suggesting this is a relatively new field of research.…”

“…The median date of publication across the studies was 2018 (range 2009–2021), suggesting this is a relatively new field of research. There were five articles (Beresford et al, 2019; Ghatorae, 2013; Glendinning et al, 2010; Golenko et al, 2021; McLeod & Mair, 2009) that included qualitative data from the perspective of reablement service professionals; however, the data from these individuals was clearly distinguishable and was excluded from the thematic synthesis. Two papers reported on data collected during the same study (Glendinning et al, 2010; Wilde & Glendinning, 2012).…”

“…A key finding across the included studies was that older people and their carers identified goals as an important measure and motivator during the reablement process and attainment of goals had a positive impact on their experience (Chung, 2019; Hjelle, Alvsvag, et al, 2017; Jokstad et al, 2020; Magne & Vik, 2020; Wilde & Glendinning, 2012). Conversely, the inability to attain goals may be discouraging for older people, resulting in a negative experience of the reablement period (Golenko et al, 2021; Wilde & Glendinning, 2012). Across the studies many older people believed that their goals were not negotiated at commencement of the reablement period with only a few older people able to recall goals after their reablement period had concluded (Beresford et al, 2019; Jokstad et al, 2020; McLeod & Mair, 2009; Wilde & Glendinning, 2012):

‘They may have had goals I don't know, but I don't remember talking to them about them’ (Beresford et al., 2019).

…”

“…When older people were able to recall their reablement goals, the focus was primarily on improving functional capacity for the completion of activities of daily living, with no consideration of social engagement (Beresford et al, 2019; Bødker et al, 2019; Chung, 2019; Golenko et al, 2021; McLeod & Mair, 2009; Östlund et al, 2019; Rahja et al, 2020; Wilde & Glendinning, 2012). A difficulty for many older people was linking the reablement interventions, such as exercises, with the goals of their reablement (Beresford et al, 2019; Jokstad et al, 2020; McLeod & Mair, 2009; Wilde & Glendinning, 2012).…”

“…In some circumstances the priorities of older people were not considered, and goals were imposed that did not align with their lifestyle preferences leading to decreased engagement during the reablement period. (Bødker et al, 2019; Chung, 2019; Golenko et al, 2021; Moe & Brinchmann, 2016; Rahja et al, 2020). Further, goal setting was often seen as a ‘new skill’ and a difficult task which was not appropriate for them given their age:

‘I think achieving my goals is history.

…”