Dr Claudia Meyer

Senior Research Fellow
Bolton Clarke Research Institute

Uptake of respite care services by carers and people living with dementia is fraught with stress, guilt and confusion. Informal carers (i.e., family and friends) are one of the main reasons that people living with dementia are able to continue living at home, in their community. However, many carers have caring-related physical and/or mental health concerns, facing up to regular negative attitudes and stigma related to dementia. Respite care services are designed to give carers a break from their caring duties, but traditional models often do not meet the needs of carers nor the person with dementia. There are complex emotions associated with respite, ranging from guilt and relief for the carer, and loss of dignity and control for the person with dementia. The recent Royal Commission into Aged Care Quality and Safety highlighted the need for innovative respite care models, acknowledging that existing services are often unavailable, inaccessible and/or unacceptable to the caregiving dyads’ needs and preferences. [1]

Respite care should be more accurately reflected as a mutually beneficial restoration of the dyad, through collaborative care partnerships. [2] Research related to respite care programs is often inconclusive, lacking the necessary depth and rigour to identify key program elements for success. Work underway at Bolton Clarke is unpacking the complex mechanisms that underpin respite care programs, especially considering a person with dementia’s transition from the community +/- hospital, into a day respite program, short stay overnight respite and potential transition into permanent care. These journeys may be carefully planned in advance or occur in response to a crisis (for the carer or the person with dementia). Respite care programs must be able to cater to the diverse needs and situations facing the caregiving dyad.

It is the right of people with dementia and their carers to live a life with dignity and autonomy, manifested through multisectoral collaboration that connects the community, acute care and residential care sectors. Currently, the system is fragmented and poorly resourced, resulting in a lack of choice and flexibility in quality respite services. Person-centred, dementia-enabling care environments are critical to fostering the authentic relationships necessary to promote trust and autonomy in respite care services. Integrating the wider community with residential care homes, through day respite programs and beyond, signals that people with dementia and their carers are valued members of society, reducing the associated negative attitudes and stigma that so often constrain the much-needed restorative break.

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.

Associate 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.

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.