Reablement, reactivation, rehabilitation and restorative interventions with older adults in receipt of home care: a systematic review

Authors:
SIMS-GOULD Joanie, et al
Journal article citation:
Journal of the American Medical Directors Association, 18(8), 2017, pp.653-663.
Publisher:
Elsevier (for the American Medical Directors Association)

Objective: To systematically review the impact of reablement, reactivation, rehabilitation, and restorative (4R) programs for older adults in receipt of home care services. Design: Systematic review. Data sources: The authors searched the following electronic bibliographic databases: MEDLINE, EMBASE, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), SPORTDiscus and The Cochrane Library and reference lists. Study selection: Randomized controlled trials that describe original data on the impact of home-based rehabilitative care and were written in English. Data extraction and synthesis: Fifteen studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed by 2 independent reviewers. Given the tailored and personalised approach of the 4R interventions, a range of primary outcomes were assessed, including functional abilities, strength, gait speed, social support, loneliness, and the execution of activities of daily living (ADL) and instrumental ADL (IADL). 4R interventions are intended to reduce the long-term use of home care services. As such, health care resource utilisation will be assessed as a secondary outcome. Results: There are 2 distinct clusters of interventions located in this systematic review (defined by hospitalisations): (1) “hospital to home” programs, in which participants are discharged from hospital wards with a 4R home care, and (2) those that focus on clients receiving home care without a hospital stay immediately preceding. Reflecting the highly tailored and personalised nature of 4R interventions, the studies included in this review assessed a wide range of outcomes, including survival, place of residence, health care service usage, functional abilities, strength, walking impairments, balance, falls efficacy and rates of falls, pain, quality of life, loneliness, mental state, and depression. The most commonly reported and statistically significant outcomes were those pertaining to the service usage and functional abilities of participants. Conclusions: From cost savings to improvements in clinical outcomes, 4R interventions show some promise in the home care context. However, there are several key issues across studies, including questions surrounding the generalisability of the results, in particular with respect to the ineligibility criteria for most interventions; the lack of information provided on the interventions; and lack of information on staff training. (Edited publisher abstract)

Subject terms:
home care, older people, rehabilitation, reablement, intermediate care, intervention, cost effectiveness, systematic reviews;
Content type:
systematic review
Link:
Journal home page
ISSN print:
1525-8610

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