Positive changes after a reablement program for older people in the Netherlands: a mixed-methods feasibility study.

backgroundIn recent years, reablement has gained increasing attention as a response to an aging population. The main goal of reablement is to empower older people to engage in and continue to perform the activities that are important to them. The Longer Active at Home (in Dutch: Langer Actief Thuis [LAT]) program is a Dutch reablement program. The aim of this study is to evaluate the feasibility of the LAT program in the Dutch healthcare context.

methodsA mixed-method study with a pre-/post-study design was conducted evaluating Bowen’s (Am J Prev Med 36:452–7, 2009) five main aspects for feasibility: acceptability, demand, implementation, practicality, and limited efficacy. Qualitative and quantitative data were analyzed simultaneously and triangulated to underlying theoretical concepts. Reflexive thematic analysis was applied to analyze qualitative data from individual interviews with older people and focus group interviews with professionals. The main quantitative outcome was the Canadian Occupational Performance Measure (COPM) to assess self-reliance. Secondary outcomes included an independence score on a Visual Analog Scale and indicated district nursing time. A multilevel linear regression analysis was used to analyze quantitative data.

resultsSeventy-two older people and 15 professionals participated in the study. Regarding demand and acceptability, professionals indicated that LAT aligns with societal trends promoting independence among older people. Furthermore, the new working approach enabled professionals to transition from a “doing for” mindset to a “doing with” mindset, with interdisciplinary collaboration identified as a key success factor—although also a challenge in practice. In terms of limited efficacy, both older people and professionals reported increased self-reliance and self-confidence in the older people. All effectiveness outcomes showed a clinically significant improvement. After the intervention, older people experienced better performance regarding their goals (COPM-P: Δ = 3.10, 95% CI 2.68–3.52) and greater satisfaction with their performance (COPM-S: Δ = 3.18, 95% CI 2.71–3.64). Additionally, they required, on average, 2 h less district nursing care per week.

conclusionsAccording to Bowen’s framework, LAT is a feasible intervention. The program enhances older people’s self-reliance and self-confidence, reduces the need for professional care, and supports healthcare professionals in switching from a “doing for” to a “doing with” approach.