Bridging the gap: From reablement policy to practice for people with dementia

In an earlier edition of Alzheimer’s & Dementia: Translational Research & Clinical Interventions, Poulos et al. [1] presented a comprehensive approach to reablement in dementia. Given there is limited ability to modify the course of the disease, they called for policymakers, clinicians, families, and people living with dementia to “focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained.” This approach of “reablement” reflects a new international policy narrative, which promotes intrinsic capacity and functional ability, as opposed to the negative discourse around aging and dependency [2–4]. In practice, however, there is often a gap between the aspirations of policy and what occurs on the ground. In the translation process it is necessary to consider the scientific evidence, the context into which the evidence must be translated, and ways in which the adoption can be facilitated [5]. To better inform practice we undertook a project to translate the evidence for reablement interventions for people living with dementia. We used recently developed national clinical practice guidelines and principles of care for people with dementia prepared for health professionals and carers in primary care, aged care, and hospital settings [6] as our starting point. We focused specifically on the recommendations that related to delaying the onset of functional decline or improving functioning, with the aim of “operationalizing” the evidence applicable to the community and residential aged care sector. We also undertook a survey of the sector to determine its understanding of reablement, and the barriers and facilitators to adopting reablement. In addition, a workshop of providers, consumers, policymakers, and academics informed the process. We updated and synthesized the relevant evidence to create a technical guide for the clinician who wants to understand the evidence; a sector handbook directed toward policymakers, service providers, and clinicians who want to gain a broad understanding of the types of reablement programs that could be offered to people living with dementia, and a consumer information booklet