Keep Able Reablement Podcasts
Keep Able is your go to authority on Wellness and Reablement. Our various podcasts cover discussions on real world issues and examples from people in the at home aged care support sector, specifically for CHSP providers.
Keep Able Reablement Podcasts
Reablement & Dementia: What Research Tells Us (P1)
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With Dr Claire O'Conner - Dementia Research - results of research program from UNSW and why reablement MUST be considered and used for positive outcomes for clients living with dementia. Also, the perspective of Allied Health professionals on using reablement with clients living with dementia.
Discover more reablement resources at keepable.com.au
Introduction
SPEAKER_00Hello and welcome to this episode of the Reablement Podcast, where Keep Able are talking to a range of people who have experience with using reablement and we will discuss how you can incorporate this into your work with older people and why it works. I'm Alison Bella from Keep Able. In this episode, I will be talking to Dr. Claire O'Connor, Senior Research Fellow from the University of New South Wales. I first met you, Claire, at a conference last year where you gave a great presentation on the benefits of using reablement for people living with dementia. I've been following you and your work ever since. So we're going to be talking specifically about allied health professionals working with clients living with dementia and how they can keep reablement at the forefront. Welcome, Claire, and thanks for joining me.
SPEAKER_01Thank you very much, Alison. I'm very happy to
Current research projects
SPEAKER_01be here.
SPEAKER_00We would love to start off by you telling us about your work and your research projects.
SPEAKER_01So I'm an occupational therapist by background, and I've been working in the field of dementia and supporting people living with dementia for about 15 years now. And my research really involves looking into how we can translate and implement non-pharmacological interventions for people living with dementia. So, how can we best support people to live as well as they can and to be as independent as possible? The work I'm doing at the moment is specifically looking at reablement and rehabilitation for people living with dementia.
Why its important to have a reablement philosophy
SPEAKER_00Why do you feel it is important to have a reablement philosophy when working with clients living with dementia by clinicians?
SPEAKER_01This is so important. So everyone living with dementia should have a right to rehabilitation. And it's something that is not broadly happening at the moment in Australia or even around the world as well. And so I guess if you think about someone who's had a stroke, they're going to be offered reablement or rehabilitation pretty soon after they've had that stroke to try and help them to be as independent as possible. But that's not happening for people living with dementia. And that's a massive gap that we need to try and address. So people with dementia also have access to rehab and reablement. Because it's about supporting people to live as independently as possible. And that applies to people living with dementia as well.
SPEAKER_00Absolutely. It's like the example you gave, that it's like a real long-term condition. So let's space all the options out instead of being reactive with what can be done for the person.
SPEAKER_01Yeah. I mean, often in dementia, people are reactive. So they wait until something's wrong or someone's struggling with something, and then they go, oh, okay, now we'll look at what we can do. But really, as soon as someone has a diagnosis of dementia, they should be people should be looking at offering them rehab early to set people up to be able to maintain their functioning for as long as possible.
What are the benefits
SPEAKER_00So what are the main benefits you can see?
SPEAKER_01It's really broad the benefits that people can achieve through participating, reablement and rehabilitation. So it really depends on what the person's interests, abilities, and needs are. But it could be physical benefits or cognitive benefits, really looking at sort of functional goals to helping people to participate in their everyday activities, social, it could be and just general well-being. And also sort of its benefits for the person with dementia, but also for the carers and the family as well, and broader benefits to society as well. Because if we support people to function as independently as possible for as long as possible, then perhaps we can delay transitions to residential care as well and keep people living in their own homes for longer.
SPEAKER_00Yes, so important.
Using reablement opportunities
SPEAKER_00Can you tell us what your research has been telling you about using reablement opportunities?
SPEAKER_01So, I mean, all the research is saying now that this is what people with dementia should be offered. So the latest Lancet Standing Commission paper, the World Health Organization, national and international dementia guidelines, the Australian National Dementia Action Plan, which came out last year, are all saying that this is what we should be doing. And the World Alzheimer's report that's coming out later this year is also all about rehabilitation for people living with dementia. So all the uh research is saying that people with dementia can benefit from this, and this is what people should be offered.
SPEAKER_00Even the research from years ago aligns with it, doesn't it? I'm thinking Kitwood, personhood from all those years ago. And that's exactly what reablement is, being person-centered.
SPEAKER_01It's definitely a personalized, sort of person-led approach for sure. We should be looking at what people's individual goals are and trying to address
How to design a reablement program
SPEAKER_01that.
SPEAKER_00Can you give me some examples of what it can look like? Any stories you've seen or heard of, and you think that is it to perfection?
SPEAKER_01Well, I mean, I guess as I said, it's very individualized. And so that's what reablement or rehab for people living with dementia should look like. It should be really looking at the person, person led, what that individual's goals are, and we should be looking at what people's abilities are. So, what can they do and what aspects of the things that they want to do are they able to do, and that's what we should be supporting them to do. So it's about multidisciplinary teams working together to help people achieve functional goals so they can be as independent as possible in their life and in the activities that they want to do. Once you've set goals with that person in collaboration with the person living with dementia and with their family as well, if appropriate, then it's about putting together a tailored program to help that person to address those goals. Whether it's a tailored exercise program or aspects of occupational therapy, working with the exercise program to help people address their functional goals, could be cognitive rehabilitation, it could be cognitive stimulation therapy. It's a whole range of allied health disciplines and approaches that could be used as part of a reablement or rehabilitation program to help people to achieve their goals. And there's freely available resources out there that people can access as well. For example, just as one example, the reablement handbook that was put together and that is freely available for people to access outlines what the evidence has said in terms of practical strategies for allied health practitioners in terms of how they might design and deliver a reablement program for someone living with dementia to address their goals.
SPEAKER_00Fantastic.
Collaboration, reviewing and updating a program
SPEAKER_00One of the key words you mentioned there is collaboration. Absolutely takes that approach, doesn't it? So regularly assessing the effectiveness of the strategy. Is it working? Does it need to be adapted, etc.? That's something you would fully support?
SPEAKER_01Yes, definitely. And that's one in the reablement handbook that I was just talking about, sort of that really clearly outlines the different sort of phases of a reablement program. And yes, there should be definitely comprehensive assessment up front to really be able to identify what someone's abilities are and how to tailor a program to address that and meet that person where they are in terms of their functioning and their abilities. And then also as that program goes on, assessment should be done again, especially in terms of maybe like an exercise program to work out if perhaps that person might be ready to have the exercises increased or made a little bit more difficult to support improvement in functioning over time as well. And people's abilities change over time as well. So we should always be aware of that and making adjustments as needed over time to continually meet that person where they
Key reablement characteristics for allied health
SPEAKER_01are.
SPEAKER_00Can you tell us what you think are the key characteristics for allied health professionals when using reablement?
SPEAKER_01Yeah, so I think rapport building with the clients that you're working with is so important. It's a really key feature to be able to work effectively with people, with anyone really. But it's really important to do that well with people living with dementia and to have really clear communication and know how to communicate well with people so people understand what the program is about and also so you're able to communicate with people to collaboratively set those goals that people want to achieve. So there's that person with dementia is really involved in how those goals are set that they want to achieve during their reablement program. And then I guess the key characteristics are things that Allied Health Practitioners should be doing anyway. You know, it's our bread and butter. That's how we got trained is to really look at setting goals, doing appropriate assessments to work out where people are, and then tailoring programs towards the person and their abilities, what the interests are, what they wants are, looking holistically at that person's environment and the context that they're living in and the supports that they have around them, and how we can leverage all of those things to deliver a program that is really targeted at what those persons' needs and abilities are. Where possible, programs should also be dyadic. So working with families at the same time, both to support families in terms of their own experiences caring for their person living with dementia that they're caring for, but also in terms of where families are able to, if they're able to support the person living with dementia to participate in the program, that can be really beneficial as well. It's not, I I do say when it's possible, because it's not always possible. Sometimes people with dementia live alone, and then that's a quite a different situation. They need extra supports there. Or sometimes families have just a lot going on and might not have capacity at that time to support a program. So it's really individualized and we need to be aware of the needs of the families as well as the person with dementia.
Goals, evaluations and outcomes that work
SPEAKER_00What sort of goals and outcomes have you seen that work to benefit the client? Have you got any examples you can uh talk to that you've come across?
SPEAKER_01I guess again, this is really individualized. I think goals that are really person-led are going to be more effective. Really goals that are really aligned with what the person's abilities are and what their interests are, what their wants are, and so and goals that are realistic, taking everything into consideration. I think when people set SMART goals, when practitioners are able to set SMART goals, I think that's really important. So that's goals that are specific, measurable, attainable, relevant, and time-bound. So that's really thinking about how are we going to evaluate whether this goal has been achieved or not, and making sure that we do re-evaluate that goal towards the end of the program and make any adjustments if needed.
SPEAKER_00Claire, have you got any examples of methods you have seen or heard of that work really well?
SPEAKER_01So, I mean, if you look at the World Health Organization package of interventions for rehabilitation for people living with dementia, that was released back in 2023 and that really outlines a range of different uh reablement or rehabilitation approaches to support different functional needs for people living with dementia. And again, if people want to look at the reablement handbook, that's also freely available, that also outlines practical strategies for designing and delivering reablement programs for people living with dementia.
SPEAKER_00And as you mentioned before, it's definitely not a one-off approach. Do you recommend that allied health professionals in particular do regular functional assessments with the client? Would that be an accurate description?
SPEAKER_01I think if you're planning a program or you want to plan a reablement program with someone living with dementia, I think evaluating the person's physical functioning, if that's something specific that you're going to be looking at. If you're going to be doing something like cognitive rehabilitation or something like that, I think understanding that person's functional cognition is really important. So functional cognition is like the way that your cognition connects to the things that you want to do. It's like the way that the person's brain is able to make their body do what they want to do. So, how does someone make themselves a cup of tea or something like that that needs a certain level of functional cognition to be able to do that? And so if we understand where someone is at in terms of their functional cognition, then you're able to design and deliver a program that's really specifically targeted towards that person's strengths and to really support them to be able to do things. So you're not going to give them something that's too difficult and not possible. And you also don't want to give some someone something that's too easy because that's boring also. And so it's really about finding that sort of Goldilocks effect of where that person's functioning is and really harnessing their strengths to support them to engage in the things
Specific examples
SPEAKER_01that they want to do.
SPEAKER_00Do you have a specific example you may have heard of, a client's story?
SPEAKER_01Let me just think of one example. Maybe someone that used to be uh really enjoying gardening, for example, but then their family member or their carer who was looking after them just didn't know how to support that person to do that anymore, I guess. And so the carer just does it for them, and that that person then is no longer doing gardening. But that's a real shame because they really enjoyed gardening and they like being outside. So it was really about recognizing what aspects of gardening that person was still able to do and really recognizing their strengths. So for this person in particular, they were actually quite mobile and really enjoyed being outside, and they just needed a bit of help in terms of setting up the activity for them and to give them sort of a bit of an understanding about what was expected of them. For example, if there were leaves to be raked up, just bringing the person outside and giving them the rake or even demonstrating with it with the rake a little bit and then handing the person the rake into their hands, and then they were able to do that activity by themselves. So it's really about supporting people and not just saying, okay, well, that person finds that difficult now, so they're not going to do it anymore. It's about going, okay, they're not allowed to do it how they used to be able to do it, but what can we do? How can we break that activity down and how can we support that person to continue to do that activity in a way that they're able to?
SPEAKER_00Yeah, I remember doing some work recently, and some of the key tips that were created from that piece of work were the importance of that initial assessment, finding out about the person, the individual, ensure you don't overstimulate them, take your time, ensure you're in a safe space, and then look at the suitable activities for their abilities. And if you can roll all of that into one, you've probably got more chance of success.
SPEAKER_01Absolutely. And everyone is different. So it's really about recognizing the needs of the person. So for example, cueing is really something that can be really supportive to help people engage in an activity, but one person might respond to visual cues or another person might respond to touch cues where you might need to touch them on the hand to help them understand what you're asking them to do, whereas another person might not respond well to touch at all. So it's very important that you understand the individual that you're working with and how best you can support them.
SPEAKER_00And do you find that allied health professionals, for example, a physiotherapist, working with someone who has been uh experiencing falls, for example, they can look at it from both a restorative and a compensatory capacity?
SPEAKER_01Absolutely. I mean, absolutely. All of this is about, I mean, when working with people with dementia, reablement and rehabilitation is about maximizing functioning where possible, but it's largely about maintaining function for as long as possible. And where there have been changes to functioning, it's about compensating for those functional changes. So, yes, and doing, you know, and it's you can be creative in those compensatory approaches and how you address them, depending on what that person's needs are and what the situation is. You might need to introduce some compensatory strategies. So it might be about bringing in assistive technology or breaking activities down into smaller steps or changing the environment around the person to support them to continue to engage in a certain way.
Barriers in reablement
SPEAKER_00What would you say people in the allied health profession might find as the biggest barriers to being able to use reablement strategies for clients living with dementia?
SPEAKER_01I mean, I'd say there's a probably a range of barriers, and it's not just specific to one area. So barriers might be around funding, for example, or staffing, perhaps, or I know that allied health practitioners, because I've been speaking to them in my research to try and understand this about barriers and enablers to being able to deliver reablement and rehabilitation for people living with dementia in the community. So it's about maybe where there's issues with communication between members of the team, maybe if there's care support workers who are contracted in from a different organization, and so maybe they don't have uh reablement philosophy themselves or they don't have time to. And so the allied health practitioners might introduce something, and then the care support workers come in and then shower the person instead of supporting the person to be able to do the aspects of showering that they're able to do themselves independently. There's a range of different uh barriers, sorry, to implementing it.
SPEAKER_00Were there any other key findings from the research you would like to talk to or point
Enablers to reablement
SPEAKER_00out?
SPEAKER_01Yeah, I mean, I'd like to talk about enablers as well as the barriers because I think the enabling factors are really important to talk about and understand as well. So I think having that team-based approach where there's really good communication between members of the team is really important. So the Allied Health team is working together to help clients address their functional goals. Where possible, incorporating and working together with other professionals like care support workers or allied health assistants to support the programs, because that can really help with sustainability of programs and making sure that people with dementia are supported in a like longer term with more intense programs than might be possible with the funding structures in place. It's about building that rapport really carefully with people living with dementia. It's about supporting family members in parallel with the reablement and rehabilitation programs where possible and delivering programs in a dyadic way where possible, where family have the capacity to participate in those programs or where family are available. So many different enablers as well that we it is important to recognize. It's not just barriers. There's a lot of positive features that once we understand, we can really leverage those to help us to deliver effective reablement programs to support people living with dementia in the community.
SPEAKER_00Fantastic. Is there anything else you'd like to share with us about using reablement by allied health professionals?
Supporting with reablement
SPEAKER_01I think just it's just so important that allied health professionals understand that people with dementia have a right to rehabilitation. And as allied health professionals, we should be offering it to people. We should be supporting people and recognizing what their abilities are and supporting people to do the things that they want to do in their life. It's just so important that people are supported to engage in activities. And I think as allied health practitioners, we have the skills to support people to be able to do that. So I think it's really important that we don't just look at someone's diagnosis and say, oh no, that person, we're not going to do reablement for that person. We'll just give them an over-toilet aid or a shower chair or something like that. We really want to look at well, how can we support this person to participate in life as much as possible and how can we support their independence? And that's something that all Allied Health Practitioners should be able to collaboratively work together to support people to do those sorts of things.
SPEAKER_00Thanks so much for sharing all of that with us, Claire. It's just been great to hear about your research projects and all of the data that you've gathered. Thank you. Thanks for having me. It's been great. To our listeners, please jump onto our website at keepable.com.au for all of the resources you need for wellness and reablement.
