Activities of Daily Living, Elderly, Reablement
Conditions
Keywords
reablement, day care center, elderly, activities of daily living
Brief summary
This study explores the effectiveness of reablement interventions for older adults with declining mobility in adult day care centers and compares them with traditional exercise interventions. In recent years, reablement has gained increasing attention. It is a person-centered approach that emphasizes goal-oriented training through activities of daily living, combined with interdisciplinary collaboration, to enhance individuals' self-care abilities and participation in daily life. In contrast, exercise interventions are typically structured programs focusing on improving muscle strength, balance, and endurance. While both approaches aim to enhance physical function, they differ in philosophy, implementation context, and motivational mechanisms. Reablement emphasizes meaningful, individualized, and context-based activities, which may enhance motivation and adherence, whereas exercise interventions are more standardized and efficient but may lack relevance to daily life, potentially affecting long-term engagement. This study adopts a quasi-experimental design to compare the effects of reablement and exercise interventions on mobility, fear of falling, activities of daily living, and subjective well-being among older adults. It also evaluates the feasibility of implementing reablement in day care centers. Additionally, participants' preferences, attendance, and engagement in different intervention approaches are examined to address the current gap in comparative research. Overall, the findings suggest that incorporating reablement into day care services-through individualized goal setting and interdisciplinary collaboration-can enhance functional performance, quality of life, and independence among older adults. The results also provide important evidence for future long-term care policy and practice, supporting a shift from a care-oriented model to a function-oriented approach, and ultimately promoting aging in place and independent living.
Interventions
BEHAVIORALReablement
Based on the principles of reablement care and incorporating the Person-Environment-Occupation (PEO) model, the intervention is designed according to older adults' individual preferences, life experiences, and functional needs. It consists of context-based, function-oriented activities embedded in daily life situations. The intervention is delivered in small groups (5-10 participants per group), where individualized reablement activities are implemented alongside shared tasks tailored to real-life contexts (e.g., community shopping, cooking, or environmental organization). A designated care staff member is responsible for facilitation, assistance, and documentation. The intervention is conducted 2 to 3 days per week, with multiple short activity sessions per day, each lasting approximately 5 to 60 minutes, over a period of 12 weeks, with a total intervention time of approximately 1,000 minutes.
BEHAVIORALExercise
The Vivifrail exercise program was adopted, an evidence-based intervention model for older adults developed based on international research (Izquierdo, 2019). Through graded, structured exercise training, the program aims to improve lower-limb muscle strength, balance, and gait function. In this study, it was used as a standardized exercise intervention for comparison with the reablement intervention. The program was delivered in small groups (5-10 participants per group), led by designated care staff. Each participant received exercise training corresponding to their functional level. The intervention was conducted 2 to 3 days per week, with each session lasting 30 to 40 minutes, over a period of 12 weeks, with a total intervention time of approximately 1,000 minutes.
Sponsors
National Taiwan University Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
quasi-experimental design
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Aged 65 years or older and assessed as Long-Term Care (LTC) need level 2 or above. * Regularly attending adult day care services at least two days per week, with no anticipated termination of services during the study period (approximately three months). * Short Portable Mental Status Questionnaire (SPMSQ) results indicating intact, mild, or moderate cognitive impairment, with the ability to understand simple instructions and participate in activities with assistance. * Able to ambulate independently (assistive devices permitted), with a Short Physical Performance Battery (SPPB) score \< 9, indicating functional decline and high risk of falls. * A score ≥ 9 on the Short Falls Efficacy Scale International (Short FES-I), indicating at least moderate fear of falling. * Willing to participate in the study and able to provide written informed consent.
Exclusion criteria
* History of fracture, major fall, or need for acute medical treatment within the past three months, or deemed by a physician to be unsuitable for moderate or higher levels of physical activity. * Presence of acute psychiatric symptoms that prevent participation in assessments or study procedures. * Severe visual or hearing impairments that interfere with activity participation or assessment. * Currently receiving other intensive rehabilitation or participating in another research intervention. * Demonstrates a clear lack of willingness to participate in the intervention or is unable to complete the three-month observation period.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mobility | From enrollment to the end of treatment at 12 weeks | Short Physical Performance Battery. It comprises three tests-balance, 4-meter walk, and chair stands-with scores ranging from 0-12, where lower scores indicate higher disability and frailty. |
| Fear of fall | From enrollment to the end of treatment at 12 weeks | Short Falls Efficacy Scale International. It is a 7-item questionnaire where individuals are instructed to score their concern of falling during an activity on a 4-point Likert scale. Scores range from 7-28, where higher scores indicate higher level of fear of falling. |
| Number and severity of falls | From enrollment to the end of treatment at 12 weeks, every week. | The Fall Record Form is used to document the frequency, location, and severity of the fall incident, and to provide additional details in the remarks section, including any injuries sustained and subsequent management or interventions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Activities of daily living | From enrollment to the end of treatment at 12 weeks | Barthel Index It is one of the most commonly used clinical tools for evaluating activities of daily living (ADL). It has a total score of 100, with lower scores indicating poorer self-care ability and a higher level of dependence on others. |
| Activities of Daily Living | From enrollment to the end of treatment at 12 weeks | Lawton IADL Scale. It is an 8-item assessment tool to measure an older adult's ability to perform complex daily tasks necessary for community living. It rates independence in areas like finances, transportation, and medication management, with higher scores (0-8) indicating greater autonomy. |
| Well-being | From enrollment to the end of treatment at 12 weeks | Chinese Happiness Inventory. It is based on the Oxford Happiness Inventory, developed by Lu Luo incorporated culturally specific sources of well-being relevant to Chinese populations. It adopts a 4-point Likert scale scoring system, with response options ranging from 0 to 3 and a total score range of 0 to 30. Higher scores indicate a greater level of subjective well-being. Considering older adults' language comprehension and life context, items originally categorized under the "work achievement" dimension were modified to reflect a broader "sense of accomplishment in daily life," thereby enhancing applicability and interpretability for the target population. |
Countries
Taiwan
Outcome results
None listed