New horizons in the compression of functional decline

Older lady looking happy

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)

Hierarchy of functional decline and compression explained

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

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).

The LifeCurve graphic

Reflective questions

This research highlights the importance of compressing (shortening) the process of functional decline in older adults. These reflective questions will help you consider how the evidence can influence individual or organisational practices. After exploring the questions, scroll down to find links to resources that can help you learn about and use LifeCurve™.
  • 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