New horizons in the compression of functional decline
Understanding Compression of Functional Decline (CFD) provides an excellent rationale and foundation for building reablement practices. In this instalment of the Evidence Hub, we present key research findings that inform the CFD framework.
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How is this research relevant to reablement practice?
This article will introduce research evidence that informs the Compression of Functional Decline (CFD) framework. It highlights the importance of proactive strategies to identify risks and delay avoidable functional decline in older adults.
The CFD framework underpinned development of LifeCurve™ which has been endorsed by the Department of Health and Ageing. LifeCurve™ is referenced in Appendix B of the 2024-25 CHSP Programme Manual (pp. 2-3). Understanding the CFD framework and LifeCurve™ helps promote reablement principles to aged care teams, clients and their support networks.
Relevance to Australian the context
The CFD framework is informed by longitudinal studies of older adults in countries all over the world, including Australia. It was evident that the age-related loss of functional abilities occurred in the same hierarchical pattern in all cohorts. Understanding this pattern assists aged care providers to intervene with the right approach and resources at the right time.
Therefore, this research and resulting framework is directly applicable to the Australian context.
Key concepts
Introduction to Compression of Functional Decline (CFD)
- The world’s population is ageing. By 2050, approximately 19% of the world’s population will be over 80 years old, representing a significant challenge to health and social services.
- Healthy ageing is not simply the absence of disease. It is:
‘…the process of developing and maintaining the functional ability that enables wellbeing in old age’ (World Health Organisation, 2015).
- Disability and dependency are feared more than death by most older people. Therefore, emphasis has shifted to maximising health span, rather than extending life span.
- Maximising health span is achieved by Compressing Functional Decline (CFD). This means condensing declines in ADL/IADL function into the shortest possible period towards the very end of life. This translates to older people having more “good years”.
- Understanding compression of functional decline supports reablement practices by:
- Helping people understand how to live better for longer.
- Identifying the most effective interventions at various stages of age-related decline.
- CFD highlights the evidence that modifiable behaviours (lifestyle choices) can influence the quality of a person’s ageing journey.
Hierarchy of functional decline and compression explained
- Research reveals that ADL/IADL functions are lost in a predicable (hierarchical) order. This consistent pattern of normal age-related decline is visually represented by the LifeCurve™ (scroll down to view).
- This pattern of age-related decline is evident across age-groups, genders and culturally diverse populations.
- The onset of functional decline varies significantly amongst individuals. For example, in Australia, the range for onset of age-related disability was 44-88 years, with a mean of 79. Therefore, CFD framework identifies “stages” of decline (not ages).
- Understanding a person’s stage of decline, helps target interventions accordingly.
- Patterns of functional decline can have different trajectories. This means that although the pattern of decline is consistent, the rate functional loss varies between individuals.
- The trajectory (rate) of a person’s decline can be influenced by disease and/or health behaviours.
- Better health behaviours have potential to compress functional decline. (i.e., a long health span with decline compressed into a short time towards the end of life).
- Conversely, poor health behaviours may result in earlier onset of functional decline with a protracted period of deterioration.
- When considering Compression of Functional Decline, the focus is on maintaining functional performance, not management of disease.
- Research indicates that Compression of Functional Decline is:
“…well understood by older adults, by their families and practitioners, and by business and policy makers”. (p.765)
Intervention approaches to compress functional decline
Four approaches are proposed to address the 4 main stages of decline.
Protection against decline (Prevention): Proactive interventions to delay the onset of functional loss.
Reactivation (Reablement): Recovering functional ability after decline has been identified.
Compensatory technology (Compensate): Using a minimally compensatory technique to regain lost ADL/IADL capacity (e.g., using a walking stick to restore ability to walk)
Personal support (Care): Tasks are undertaken by another person when the individual loses the ability to do the task themselves. Providing “care” will not arrest decline. However, providing proactive interventions earlier can minimise time in this stage.
Note: These stages are visually represented on the LifeCurve™. Scroll down to view the LifeCurve™ and use the Reflective Questions to explore these concepts further.
Benefits of understanding CFD research
- Compressing functional decline enables older people to remain active and have more good days in their later years. This is congruent with the principles of wellness and reablement.
- The onset and rate of age-related functional decline is significantly affected by lifestyle choices.
- Individuals can influence their ageing trajectory with positive lifestyle choices. Importantly, this includes maintaining participation in IADL and ADL tasks for as long as possible.
- LifeCurve™ is a visual tool that helps providers communicate the impact of individual lifestyle choices and potential strategies to slow functional decline.
- CFD evidence demonstrates that onset and rate of decline can be influenced with the right intervention approach. LifeCurve™ can support providers to identify the right approach for clients.
- Ideally, services will provide early, proactive interventions to delay functional decline. If decline has already occurred, providers should select the intervention type that best promotes functional performance.
- Interventions rated most to least proactive are:
- Prevention
- Reablement
- Compensation
- Care
Note: The hierarchy of functional losses and related intervention approaches are identified on the LifeCurve™. (Prevention strategies are applicable to individuals functioning in the zone above the red dotted line).
Reflective questions
Have I/our team/our organisation seen LifeCurve™?
Do I/we understand what LifeCurve™ is demonstrating? (i.e., could I explain this to a colleague, client, etc?)
Do I/we understand how LifeCurve™ can inform wellness and reablement approaches?
Can I/we identify the four significant stages of function and the associated intervention approaches?
Did I/we know that the first warning sign for significant functional decline is the inability to cut toenails?Do we effectively share the evidence for healthy ageing with our clients? Could we use LifeCurve™ to help?
(Remember, CFD is “…well understood by older adults, by their families and practitioners…”)
Do we/can we use the evidence for healthy ageing (e.g., LifeCurve™) to promote client engagement in reablement programmes?
Do our clients understand that accepting “compensation” or “care” prematurely, reduces their potential to live safely and independently at home?
Do our clients understand that their lifestyle choices can impact the trajectory of age-related changes? With the guidance they can help themselves to have more good days.Do I/we make assumptions about what a person can do, based on their age?
Are we good at identifying the best approach to service interventions, based on the client’s stage of functional decline (not their age)?
Does our team understand that offering “compensation” or “care” prematurely reduces clients potential to live safely and independently at home?When I meet a client and identify their current functional abilities, do I consider where they rate on the LifeCurve™? Do I consider their risk for future independence based on this knowledge and evidence?
Do we provide clients information/services that help protect against decline or do we respond to decline after it has occurred?
Resources that can help
LifeCurve™ is a framework that powerfully represents common patterns of age-related decline and opportunities for intervention. It is evidence-based and aligns directly with wellness and reablement principles.
KeepAble has developed a variety of resources to help you learn about, and effectively use the LifeCurve™. On KeepAble you can find:
A two-part, eLearning course: An evidence-based tool to promote Reablement: Introducing LifeCurve™ – Part 1, The Power of LifeCurve™ – Part 2
You can also find downloadable PDF resources about LifeCurve™.
You can review the full article here: New horizons in the compression of functional decline
Gore et al. Age and Ageing, Volume 47, Issue 6, November 2018, Pages 764-768