Associte Professor Lucy Lewis
Interim Dean People and Resources; Academic Lead Physiotherapy
Flinders University
Population ageing is accelerating rapidly. Globally, in 2019, there were 703 million persons aged 65 years and older, with this number projected to increase exponentially, reaching 1.5 billion in 2050. As populations age, there is increased demand for aged care which encompasses a range of services, from home support, to long term residential aged care. In Australia, more than 1.2 million people receive aged care services (approximately one quarter in residential care), and this is expected to grow two-fold in the next 30 years (1).
Aged care residents are at high risk of physical deconditioning due to their age, functional impairment, co-morbidities and sedentary behaviour. Physical deconditioning is the physiological change from inactivity that results in decreased muscle mass, weakness, functional decline, and difficulty performing daily living activities. Physical deconditioning is a hallmark of frailty, an age-associated clinical syndrome reflecting decreased physiological reserves and increased susceptibility to the impacts of external stressors. It is estimated that approximately 2.1 million Australians aged 65 and over are pre-frail or frail, with this set to increase rapidly in the coming decade. The prevalence of frailty is even higher in residential aged care, with our recent large-scale audit of 1241 Australian aged care residents finding that 75% of residents were frail, and 19% pre-frail, with time in the residential aged care setting and age predicting frailty (2).
Exercise has been shown to be an effective countermeasure to physical deconditioning among people living in residential aged care. The benefits extend past falls prevention and increased physical and mental wellbeing, to positive financial implications. Programs aimed at promoting physical function have the potential to improve residents’ wellbeing and align to current aged care standards. The Australian Royal Commission into Aged Care Quality and Safety advocated a ‘wellness and reablement’ approach in residential aged care, including exercise programs to promote resident function, participation, and independence. Reablement is a term used generally to describe a targeted, time-limited approach that promotes the regaining or maintenance of functional performance. Reablement specifically in aged care refers to programs that help individuals re-establish daily living skills through goal-oriented programs.
There are inconsistencies in the levels of support residential aged care facilities provide for reablement pathways of residents. Challenges for organisations include resourcing, organisational culture, funding models, and staff knowledge, experience, and skills. Our recent review explored the evidence for reablement in residential aged care, including features and effectiveness, cost, and resident acceptability (3). There is a lack of evidence in the Australian context. Nearly all identified reablement programs were developed without consultation regarding residents’ preferences. Most of the programs improved resident physical function, just under half improved quality of life and a quarter improved mental health. Programs with more than one exercise type (e.g., strength training and walking) most commonly improved physical function. Only a few studies asked residents whether the programs were acceptable, and none measured cost effectiveness. Measures of physical function and frailty were inconsistently applied and lacked standardisation.
There is a clear need to re-think the development of reablement programs in residential care to ensure they are effective, consistent, sustainable, cost effective and acceptable to residents. A consistent battery of measures to continually monitor physical function and reablement programs should be established. The move to a wellness and reablement approach in residential aged care in Australia is positive, however, it is time to involve residents and other stakeholders in the planning, development, and delivery of these programs.