Syfte: Syftet med litteraturöversikten var att beskriva arbetsterapeuters erfarenheter av reablement som tillvägagångsätt i vardagsrehabiliteringen hos hemmaboende äldre personer. Metod: En allmän litteraturöversikt av kvalitativa studier valdes som design för att sammanställa den tidigare forskningen som besvarade studiens syfte. Datainsamling skedde från två databaser inom medicin och hälsa. Data från tio kvalitativa artiklar sammanställdes och analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analysen resulterade i fem kategorier; att kartlägga, bedöma och strävan efter att sätta upp aktivitetsfokuserade mål, att stödja den äldre personen till självständighet och delaktighet i meningsfulla aktiviteter, att följa upp och att motivera till en fortsatt rehabilitering, att samarbeta i ett interdisciplinärt team och att samarbeta med anhöriga samt ett övergripande tema; betydelsen av ett personcentrerat förhållningssätt och att ha en samsyn. Slutsats: Essensen med reablement var att i ett interdisciplinärt samarbete stödja de äldre personernas självständighet och delaktighet i de dagliga aktiviteterna. Arbetsterapeuterna hade en grundläggande roll med att förverkliga ett personcentrerat förhållningsätt och en samsyn i det interdisciplinära teamet inklusive den äldre personen och anhöriga. Enligt arbetsterapeuterna förutsatteförverkligandet en gemensam målsättning, ett välorganiserat interdisciplinärt samarbete med avsatta resurser under en begränsad tid och goda kommunikationsstrategier. / Purpose: The purpose of the literature review was to describe occupational therapists’ experiences of reablement as an approach in everyday rehabilitation of home-dwelling older adults. Method: A general literature review of qualitative studies was chosen as a design to compile the previous research that answered the purpose of the study. Data collection took place from two databases in medicine and health. Data from ten qualitative articles were compiled and was analyzed with a qualitative content analysis. Results: The analysis resulted in five categories; to map, assess and strive to set activity-focused goals, to support the olderperson to independence and participation in meaningful activities, to follow up and motivate to a continued rehabilitation, to collaborate in an interdisciplinary team and to collaborate with relatives and an overarching theme; the importance of a person-centred approach andhaving a consensus. Conclusion: The essence of reablement was to support the older people’sindependence and participation in daily activities in an interdisciplinary collaboration. The occupational therapists had a fundamental role in realizing a person-centered approach and a consensus in the interdiciplinary team including the older person and relatives. According to the occupational therapists, the realization required a common goal, a well-organized interdisciplinary collaboration with allocated resources for a limited time and good communication strategies.

Yes / Objectives: To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. Design and methods: Parallel group multi-centre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer’s, vascular or mixed dementia and mild-to-moderate cognitive impairment (MMSE score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received ten weekly sessions over three months and four maintenance sessions over six months. Participants were followed up three and nine months post-randomisation by blinded researchers. The primary outcome was self-reported goal attainment at three months. Secondary outcomes at three and nine months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition, and study partner stress and quality of life. Results: We randomised (1:1) 475 people with dementia; 445 (CR=281) were included in the intention to treat analysis at three months, and 426 (CR=208) at nine months. At three months there were statistically-significant large positive effects for participant-rated goal attainment (d=0.97, 95% CI 0.75 to 1.19), corroborated by informant ratings (d=1.11, 0.89 to 1.34). These effects were maintained at nine months for both participant (d=0.94, 0.71 to 1.17) and informant ratings (d=0.96, 0.73 to 1.2). The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. Conclusions: Cognitive rehabilitation enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy. / National Institute for Health, Health Technology Assessment Programme, Grant/Award Number: 11/15/04

Background  Occupation-focused and occupation-based interventions can potentially promote occupational engagement among community-dwelling older people, but there is limited evidence to identify the most effective and cost-effective interventions. For independent-living older people, there is a lack of evidence to determine if occupation-focused and occupation-based interventions have an effect on their occupational engagement. For older people who need assistance because of bathing disabilities, there is limited evidence of the effects of occupation-focused and occupation-based interventions on their occupational engagement or for reducing or omitting their need for assistance. Finally, there is limited evidence to determine if occupation-focused and occupation-based interventions implemented for community-dwelling older people are cost effective. Aim The aim of this thesis was to evaluate the effects and cost effectiveness of occupation-focused and occupation-based interventions for two groups of community-dwelling older people, independent-living, community-dwelling older people and older people with bathing disabilities. Method Studies I and II were based on an exploratory randomized controlled trial. One hundred and seventy seven persons, 77–82 years, single living, and without need for home help were randomized to a no-intervention control group or to one of three occupational therapy interventions focused on promoting occupational engagement: an individual intervention, an activity group or a discussion group. In study I, effect sizes for leisure engagement and ability to perform activities of daily living (ADL) tasks were estimated for each intervention in relation to the control group to identify the most effective intervention at 3 and 12 months after baseline. In study II, the effects on quality adjusted life years (QALYs) and the total costs for the intervention, social services provided by the municipality and health care were used evaluate cost-effectiveness. Study III was a quasi-experimental clinical trial and included 95 persons, 65+, who had applied for municipality-based home help with bathing. For participants in the intervention group, occupational therapists implemented occupation-focused and occupation-based interventions. No occupational therapy intervention was implemented for those in the control group, but they were allocated home help services if judged to need it based on an assessment by a municipality care manager. Evaluations of ADL ability, self-rated health and allocated home help were implemented at baseline and after 15 weeks. Study IV involved the use of decision-modeling based on a five state Markov model that included levels of dependency in ADLs, place of residency and death. Probabilities for transitions between states in the model, QoL scores and societal costs for each state were derived from previous research. Overall, the model was based on research indicating that more severe levels of dependency reduced QALY scores and increased societal costs. Previous trials have provided evidence that an occupation-focused and occupation-based intervention implemented to reduce bathing disabilities increased the probability of independence of home help. The Markov model was used to evaluate cost-effectiveness over 8 years for an intervention compared to no intervention. Results The results of study I indicated that each intervention had a small positive effect on minimizing a decline in leisure engagement and/or ADL, but no intervention was clearly superior. In study II, the results indicated that the interventions delivered in a group format positively affected self-rated health. The discussion group was the most cost-effective intervention. The results of study III indicated that the intervention had no effect on ADL ability or self-rated health. There was, however, a large difference in the allocation of home help at follow up, indicating that the intervention was effective in reducing dependency on home help for bathing. The results of study IV indicated that compared to no intervention, the intervention resulted in a positive accumulation of QALYs and lower costs for every year during the entire 8 year period. Conclusion This thesis provides evidence to support the implementation of occupation-focused and occupation-based interventions for independent-living, community-dwelling older people in order to reduce their decline in occupational engagement and improve their self-rated health; the interventions also have the potential to be cost effective. This thesis also provides evidence that an occupation-focused and occupation-based intervention implemented for older people with bathing disabilities was effective in promoting independence from home help for bathing. Finally, an occupation-focused and occupation-based intervention that increased the probability of being independent of home help for bathing had a positive impact on the long term accumulation of QALYs and reduced societal costs and, therefore, can be considered very cost effective.