Dr Claire Gough 

Research Fellow, ARIIA

As we age, our focus shifts from work to other activities that give us a sense of purpose and enjoyment. However, "Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities" (Royal Commission into Aged Care Quality and Safety, 2019). By 2066, it is expected that 23% of the Australian population will be aged 65 years and over (AIHW, 2024). This presents the aged care sector with the task of deciphering how to care for larger populations and support individuals to age well.

Allied health professionals, including occupational therapists, physiotherapists, exercise physiologists, podiatrists, and dietitians (among others), are experts in preventing, diagnosing, and treating a range of chronic conditions (AHPA, 2024). Allied health professionals have the skills to enhance and maintain functional mobility (which often declines with age), manage pain, and support ongoing independence. Therefore, the involvement of allied health professionals in aged care delivery can empower individuals to maintain function and participate in activities they enjoy.

At the 2024 ARIIA conference, we were joined by a panel of experienced allied health professionals to discuss "Ageing Well – Social Care, Allied Health, and Prevention." Hilary O’Connell described the decline and dependencies demonstrated with ageing and highlighted the importance of reablement to support individuals to be as independent as possible. Hilary suggested that increasing exercise can support the restoration of function and is often the difference between living at home and requiring residential aged care. Rik Dawson presented a range of technologies useful for increasing mobility and balance, suitable for use in aged care to support individuals to "thrive in older age." Rik discussed the complexities of providing physiotherapy in relation to current funding models. Stacey George presented outcomes from an evaluation of early intervention initiatives for healthy ageing in primary care, putting the spotlight on the need for quality-of-life measures across the ageing trajectory.

Questions from the floor shifted the focus from mobility, physiotherapy, and occupational therapy to the need for oral care and access to dentistry. There was rich discussion around the importance of maintaining oral health to support sufficient dietary intake, enabling older people to mobilize and participate in activities. Access to oral care and dentistry is perhaps overlooked in aged care and requires more attention to ensure that older people are ageing well. As usual, discussions turned to funding. While the benefits of allied health services in aged care are clear, the ability to access these professionals more regularly seemed to be restricted. Support for allied health is required to ensure that older people can maintain their independence, quality of life, and age well into the latter years of life.

We would like to thank Hilary O’Connell, Rik Dawson, and Stacey George for joining us at the ARIIA 2024 conference and sharing their expertise with us.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

​​Dr Stephanie Champion​

​​Postdoctoral Research Fellow
​ITP Facilitator, ARIIA​

ARIIA’s Innovator Training Program (ITP) allows individuals and teams working in aged care across Australia to design and pitch sustainable, evidence-based solutions to challenges and opportunities for improvements they have identified in their organisation.  

In August 2023, ARIIA held the first three themed training programs focused on building reablement capabilities in the aged-care workforce.  

To support the implementation of projects with evidence-based solutions, ARIIA has developed specialised resources for the Innovators (participants) in the themed rounds, but they are freely available to anyone in the sector. We have had high engagement with the ITP pages and downloadable content since the launch of the reablement theme, with over 700 views across the reablement evidence pages. These resources have been essential for this topic, helping the audience distil the key information; as in the words of one of our Innovators, “There's a lot of confusing evidence out there". The Innovators also benefited from the expertise of guest Facilitator Dr. Claire Gough, a physio and researcher who works for ARIIA. 

Using resources and evidence collated by the Knowledge and Implementation Hub (KIH), Innovators have uncovered the underlying issues that contribute to the limited success of current reablement programs in their organisation.  

All Innovators recognised that aged care staff lacked consensus on what reablement activities could look like, which was a key barrier to implementing successful reablement programs. As a result, the Innovators acknowledged that the first step of any implementation project would be to get everyone on the same page regarding the scope and opportunities of reablement solutions.   

The Innovator's project plans have included a wide array of reablement solutions that involve working with older people to identify goals and opportunities to access reablement services to enable them to age in place comfortably. Some of the projects are built on existing programs, and others introduce new service options for older people. Each project incorporates strong co-design elements, as Innovators realise the importance of involving consumers and the local staff in delivering care in the planning process.  

Through the ITP, ARIIA aims to support the creation of practical reablement projects and enhance Innovators' skills in evidence searching, project planning, and management for future projects. We hope through these projects; Innovators will demonstrate to their organisation the transformative power of the ITP, the staff's passion and the opportunities for innovation in the reablement space.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Dr Claire Gough

ARIIA, Flinders University

Aged care services are a critical aspect of society given the increasing age of our population. Older adults are entering the latter years of life with more chronic conditions than before and often require assistance to live independently in their own homes or move to residential aged care facilities. In recent years, there has been a push for reablement to be integrated into aged care. Reablement is a person-centred approach that aims to empower older people to regain skills and independence, moving away from the traditional ‘passive care recipient’ to an ‘active participant,’ encouraging ownership and self-driven independence. [1] Reablement has the potential to improve an individual's quality of life, as older people are supported to regain their independence, this may reduce long-term care needs, and subsequently the workload of the aged care workforce.

In August 2023, the ARIIA Knowledge and Implementation Hub (KIH) will be supporting ARIIA’s Innovator Training Program (ITP) to provide a specially themed ITP program on how to integrate reablement approaches into aged care service delivery. This topic was nominated by the aged care sector as a high priority issue via ARIIA’s annual national survey. This need corresponds with the Australian Government’s recommendations for reablement to be integrated into aged care services to improve the quality of aged care delivery [2, 3] This reablement-themed ITP will be delivered over 10-weeks via online learning modules and co-design workshops that aim to assist participants understand a specific problem around the integration of reablement in their service, find a best-practice evidence-based solution that they can adapt to their situation, and plan a measurable outcome for change. To support the program, the KIH have carried out an environmental scan to identify resources that may be useful to support care workers increase the independence of older people in their care. These resources can be found on the ARIIA website here, and are supported by the ‘Rehabilitation, reablement, and restorative care’ priority topic which can be accessed here.

This ITP program is an exciting opportunity to inform the aged care workforce and support the independence of older adults receiving care. To expand on this body of work and inform future approaches in this space, the KIH will be holding a round table at the end of 2023 to determine the state of play for reablement in aged care. These discussions will involve key stakeholders and aim to identify barriers to reablement approaches in the day-to-day delivery of aged care and ways to facilitate reablement to achieve best outcomes for older people.

If you are interested in being involved in these round table discussions, please email KIH@ariia.org.au

1. Maxwell H, Bramble M, Prior SJ, Heath A, Reeves NS, Marlow A, et al. Staff experiences of a reablement approach to care for older people in a regional Australian community: A qualitative study. Health Soc Care Community. 2021;29(3):685-693.  
2. Department of Health and Aged Care (Australia). Commonwealth Home Support Programme: Program manual 2023-2024 [Internet]. Canberra, ACT: DoHAC; 2018 [updated 2023 Jun; cited 2023 Aug 2]. Available from: https://www.health.gov.au/resources/publications/commonwealth-home-support-programme-chsp-manual
3. Royal Commission into Aged Care Quality and Safety. Final report: Care, dignity and respect - Volume 1 summary and recommendations [Internet]. Canberra, ACT: Commonwealth of Australia; 2021 [cited 2023 Apr 16]. Available from: https://agedcare.royalcommission.gov.au/publications/final-report-volume-1  

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Dr Chad Han

Caring Futures Institute, Flinders University

Pre-frailty and frailty are clinical syndromes that increase an older adult’s risk to higher dependency and are associated with lower survival rates. [1, 2] This is especially important as many older adults already live with multiple chronic conditions such as metabolic diseases and cancers, that make them vulnerable. Frailty (physical) can be described as a syndrome when three or more of the following conditions are present: low physical activity, slow walking speed, unintentional weight loss, weak grip strength, and self-reported exhaustion. [2] Frailty (inclusive of domains other than just physical) can also be defined as deficits in cognition, general health status, functional independence and performance, social support, medication use, nutrition, mood, continence etc. [3] Pre-frailty, as its name suggests, is a state prior to the spectrum of frailty, though a consensus of its definition is underway. [4]

There is a high prevalence of pre-frailty and frailty in Australia. In a cohort of 329 hospitalised older adults at Flinders Medical Centre in Adelaide, more than half (n=220) were either pre-frail or frail, according to the Edmonton Frail Scale. [5] The acute stress of hospitalisation makes it harder for older adults to ‘bounce back’ as they get discharged [1]. There are ways to alleviate that. Multifaceted interventions combining exercise and nutrition as part of management strategies are recommended by The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group for pre-frail and frail hospitalised older adults. [6] However, the sustainability of these treatments is questionable, and involving a more collaborative partnership approach with patients may be equivalent as existing models but better reduce burden on healthcare resources.

The INDividualized therapy for Elderly Patients using Exercise and Nutrition to reduce depenDENCE post discharge (INDEPENDENCE) pilot program was developed by a group of researchers at Flinders University involving dietitians (Professor Michelle Miller, Dr Alison Yaxley, Dr Chad Han – as part of his PhD with College of Nursing and Health Sciences, Flinders University), a physiotherapist (Dr Claire Baldwin) and a physician (A/Prof Yogesh Sharma). The novelty of this program was the adaptation for pre-frailty and frailty of a chronic condition self-management model developed by Professor Malcolm Battersby, initially for self-management of conditions such as diabetes. [7] The pilot randomised controlled trial, recently published in Clinical Interventions in Aging, showed promising results on the preliminary effectiveness and acceptability of such a self-management hospital-to-home program. [8]

The trial highlighted that this self-management model was well received by participants, having an average participation in activities/visits of above 90%. [8] There were significant improvements in the Edmonton Frail Scale at 3 months (after the active support ended) and a legacy effect at 6 months (3 months after active support was removed). To understand more about the barriers and facilitators to this program, participants of the intervention group were also interviewed. The barriers and enablers we identified highlight the unique and individualized needs of older adults which can aid or hinder adherence (manuscript under preparation).

Intentions, Social influences, Environmental context/resource, and Emotions served as primary barriers towards adherence to both exercise and nutrition components. For example, a participant shared how depressive mood could prevent her from eating better and moving: ‘Now I hate getting out. I just like staying in my bed. I think the earlier I get up, the longer the day is.’ Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. For example, the acknowledgement of benefits of exercise encouraged a participant to keep doing her exercises: ‘And I knew it was going to build up stamina and give me strength again. So there was a big incentive.’

Want to know more about the INDEPENDENCE pilot program?

• Watch Chad and Barbara (a participant on the INDEPENDENCE program), as they chat about research and the INDEPENDENCE pilot program: https://www.youtube.com/watch?v=zgVLrwdO5NI
• The idea behind this INDEPENDENCE program was also presented at the Asia Pacific finals of the 3-minute thesis competition: https://vimeo.com/632502129

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.