Rudi GJ Westendorp, is Professor of Medicine at Old Age at the Department of Public Health and Centre for Healthy Ageing, University of Copenhagen. In this blog he discusses his recent Age and Ageing paper New horizons: Reablement – supporting older people towards independence.
The majority of older people wish to remain independent and live in their own homes for as long as possible. Instead maintaining a cruising altitude however, the process of ageing forces many to descend towards dependency and long-term care.
It’s never too late to learn new ways for coping by yourself and to make preparations for independent living in older age. But it is a shame that too often these good intentions are superseded by doubts and avoidance. We need to ask who is doing sports regularly at 72 when in general this is considered appropriate for “boys and girls”? Who is investing in making new friends at 78 when some of their loved ones have passed away? Who is shopping with a neighbour for comfort and security at 85? These types of activities form the ultimate recipe for how older people can remain independent and in their own homes. Far too often we are just waiting for deficiencies to present themselves, listening only when people ask for help and then responding with long term care provisions. There is a growing literature showing that it is almost never too late to benefit from specific interventions which they address the physical, psychological or social aspects of everyday life.
In Denmark since the beginning of 2015, it is mandated by law that municipalities should offer ‘reablement’ services when their citizens apply for assisted services. The basic idea is to deliver a transformative change in the health-services sector towards empowering citizens to do things for themselves rather than doing it to for them. Cynics view these services as an impingement on their personal rights and consider it a moral excuse for government to implement yet another round of austerity measures. But is there any sensible argument against enabling citizens to pursue their personal goals and remain independent?
My personal epiphany was whilst I was visiting Jutland in 2011. The Danish municipal workers taught me how they deliver ‘restorative care’. They introduced me to an 82-year man who had experienced a family bereavement not long before. I knew from my surgery and statistics that he suffered a very high risk of adverse outcomes. He was offered an intensive, six-week intervention focussing on supporting him to regain skills like washing, ironing and cooking; in other words the skills to be able to take up life again.
Reablement just seems like the right thing to do which begs the question, why do we feel so uncomfortable with the idea?