Reablement in home-dwelling older adults

Abstract

Background: Reablement is an alternative approach to home-based services for older adults at risk of functional decline. It is time-limited and aims to promote independence by offering a multidisciplinary, individualised and goal-directed intervention. The Canadian Occupational Performance Measure (COPM) is an instrument designed to help participants identify, prioritise and evaluate occupational performance (COPM-P) and satisfaction with performance (COPM-S) of important occupations. The COPM is the main instrument for goal determination and evaluation in Norwegian reablement. Objectives: To investigate psychometric properties of the COPM used on an interprofessional basis, to explore potential factors predicting outcomes following reablement, and to evaluate the effectiveness of reablement in home-dwelling older adults. Methods: The PhD project is based on two cohort studies (the psychometric study and the prediction study) and one randomised controlled trial (the effectiveness study). Results: The results show that the COPM has adequate content validity, construct validity and feasibility in a population of home-dwelling older adults, and a moderate responsiveness to change. The minimal important changes are 3.0 and 3.2 points for COPM-P and COPM-S, respectively. High baseline scores of COPM-P and COPM-S, female gender, having fracture as the major health condition and high motivation for rehabilitation predict better outcomes. Home-dwelling older adults benefit from reablement by improving their self-perceived performance and satisfaction with performance in prioritised daily occupations. Conclusion: This PhD project demonstrates that the psychometric properties of the COPM are adequate in an older, heterogeneous and home-dwelling population. The results support the use of COPM in clinical practice and research in this population. Furthermore, the results show that diagnosis, gender, motivation and functional level are significant predictors of outcomes of reablement. Lastly, this thesis confirms that reablement is an effective intervention when it comes to improving performance and satisfaction in everyday life.