The effects of reminiscence therapy on psychological well-being, depression, and loneliness among the institutionalized aged

Article (PDF Available)inInternational Journal of Geriatric Psychiatry 25(4):380-8 · April 2010with1880 Reads
DOI: 10.1002/gps.2350 · Source: PubMed
Abstract
To examine the effects of reminiscence therapy on psychological well-being, depression, and loneliness among institutionalized elderly people. In an experimental study design, 92 institutionalized elderly people aged 65 years and over were recruited and randomly assigned to two groups. Those participants in the experimental group received reminiscence therapy eight times during 2 months to examine the effects of this therapy on their psychological well-being. After providing the reminiscence therapy to the elderly in the experimental group, a significant positive short-term effect (3 months follow-up) on depression, psychological well-being, and loneliness, as compared to those in the comparison group was found. Reminiscence therapy in this study sample improved socialization, induced feelings of accomplishment in participants, and assisted to ameliorate depression.

Figures

The effects of reminiscence therapy on psychological
well-being, depression, and loneliness among the
institutionalized aged
Kai-Jo Chiang
1,2
, Hsin Chu
3
, Hsiu-Ju Chang
4
, Min-Huey Chung
2
, Chung-Hua Chen
5
,
Hung-Yi Chiou
6
and Kuei-Ru Chou
2,7
1
Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
2
Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
3
Institute of Aerospace Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
4
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
5
School of Nursing, Mei-Ho Institute of Technology, Pingtung, Taiwan
6
School of Public Health and Dr. Chi-Hsin Huang Stroke Research Center, Taipei Medical University, Taipei, Taiwan
7
Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
Correspondence to: Prof. K.-R. Chou, PhD, E-mail: kueiru@tmu.edu.tw
Objectives:
To examine the effects of reminiscence therapy on psychological well-being, depression, and
loneliness among institutionalized elderly people.
Methods: In an experimental study design, 92 institutionalized elderly people aged 65 years and over were
recruited and randomly assigned to two groups. Those participants in the experimental group received
reminiscence therapy eight times during 2 months to examine the effects of this therapy on their
psychological well-being.
Results: After providing the reminiscence therapy to the elderly in the experimental group, a significant
positive short-term effect (3 months follow-up) on depression, psychological well-being, and loneliness,
as compared to those in the comparison group was found.
Conclusions: Reminiscence therapy in this study sample improved socialization, induced feelings of
accomplishment in participants, and assisted to ameliorate depression. Copyright # 2009 John Wiley &
Sons, Ltd.
Key words: reminiscence therapy; elderly; depression; psychological well-being; loneliness
History: Received 15 April 2009; Accepted 4 June 2009; Published online 20 August 2009 in Wiley InterScience
(www.interscience.wiley.com).
DOI: 10.1002/gps.2350
Introduction
With advances in medical technology, the life
expectancy of people globally is increasing. This trend
has contributed to an aging population worldwide. For
example, in 2005 the global elderly population over
65 years of age was 7.4%; this percentile is projected to
increase to 16.1% by the year 2050 (United Nations
Population Division, 2009). In the United States, there
were approximately 38.7 million people aged 65 years
and over in 2008; this number is projected to more
than double to 88.5 million in 2050 (U.S. Census
Bureau, 2008). In Taiwan currently 10.43% (2 402 220)
of the population is over the age of 65, and this ratio is
predicted to increase to 14.4% by the year 2020
(Taiwan Council for Economic Planning and Devel-
opment, 2008).
As people age and move toward retirement they can
experience a loss of physiological, psychological, and
social function and involvement. Indeed, such losses
are variable and not all aged people need care or
support, nor are they necessarily dependent; however,
in some cases such loss of function and capability can
leave the person emotionally and physically vulnerable.
For some aged persons, depression, for example,
exacerbates the issues surrounding social deprivation,
RESEARCH ARTICLE
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
loneliness, and a diminished social role. Depression
can also involve suicidal ideation and intent.
A 2006 survey reported that 35–84% of the
community elders aged over 65 years in America
experienced loneliness (Lauder et al., 2006). In a 2005
report from the Department of Statistics, Taiwan
Ministry of Interior, it was highlighted that 21.8%
of Taiwanese community elders were also lonely.
Wang et al. (2001) suggests, from a rural perspective,
that approximately 60.2% of the community elders
surveyed experienced severe loneliness. Issues of de-
pression, self-identity, loneliness, and challenges
associated with coping with change due to aging are
especially important issues for institutionalized elders
in eastern culture. Validation therapy, reminiscence
therapy, and cognitive behavioral therapy have been
addressed in the literature as three of the major
treatment approaches used in the emotional care of the
elderly person.
Recently, the use of the reminiscence therapy in
Taiwan has become common and the effectiveness of
this therapy has been beneficial in the care and support
of the elderly person who is institutionalized in care.
Furthermore, reminiscence therapy is successful in
improving one’s comprehension skills and in boosting
self-esteem, to ease the feeling of depression and
hopelessness, and to enhance self-integration. Many
studies point out the positive effects of reminiscence
therapy and highlight its effectiveness in the easing of
depressed feelings (Bohlmeijer et al., 2003; Hsieh
and Wang, 2003; Husaini et al., 2004; Wang, 2005;
Pinquart et al., 2007), it is also known to be beneficial
to an aged persons psychological well-being (Tatchell
and Jordan, 2004; McKee et al., 2005; Zauszniewski
et al., 2006), it assists to ease feelings of loneliness (Liu
et al., 2007), and can ameliorate negative emotions and
anxiety (Chou et al., 2008). Reminiscence therapy does
have a role in the maintenance of self-esteem (Lin et al.,
2003; Chao et al., 2006; Nomura and Hashimoto,
2006), self-value (Baker, 1985), better coping skills
(Nugent, 1995), increased satisfaction with life (Cook,
1998; Lin et al., 2003), enhanced self-integration
(Stinson and Kirk, 2006; Zauszniewski et al., 2006),
enhancement of functional activities (Kovach and
Henschel, 1996; Woods et al., 2005; Zauszniewski
et al., 2006), improved social functions and activities
(King, 1982; Cook, 1991), prevention of behavioral
problems (Kovach and Henschel, 1996), and in the
effective care of the aged person (Shellman, 2007).
Nevertheless, despite its reputation as an effective
approach in the care of the aged person with dementia
and in the context of those persons retired and in
care, a randomized clinical trial for measuring the
outcome of reminiscence therapy is lacked. Research
in the areas of reminiscence therapy is limited in
Taiwan and it is not clear if such interventions are
helpful in the eastern culture. Therefore, this study
aimed to observe the effect of reminiscence therapy on
improving the psychological well-being of institutio-
nalized elderly persons in Taiwan.
Evidence-based studies of reminiscence therapy on
depression treat ment
Reminiscence therapy has been proven to be beneficial
to the elderly because it reduces depression and
negative feelings. It also enhances self-integration.
According to the literature, reminiscence therapy is
usually provided to the elderly person with depression
about 6–12 times, 1–2 times weekly, and in a 40–
60 min session (Ashida, 2000; Jones, 2003; Wang, 2005,
2007; Beth, 2006). The evaluation of reminiscence
therapy was done using the following tools: Geriatric
Depression Scale short form (GDS-SF); Cornell Scale
for Depression in Dementia (CSDD), and Hamilton
Rating Scale of Depression (HRSD). Results from
previous studies have shown that reminiscence therapy
improves depressive symptoms, with the average
GDS-SF score falling from 13.7–6.36 points to 12.3–
4.29 points, and the average CSDD score decreasing
from 7.37 to 6.23 points (Ashida, 2000; Jones, 2003;
Wang, 2005, 2007; Beth, 2006). The positive effects
persisted when measured at 1 and 3 years post-therapy
( p < .05) (Haight et al., 2000). These results support
the contention that reminiscence behavior is adaptive
and that it can produce a positive effect on depressed
mood states in the elderly.
Evidence-based studies of reminiscence therapy on
psychological well-being
Reminiscence is highly associated with pleasure,
security, health, and a feeling of belonging to a place.
The positive ability (to recall good things, be prepared
for death, and be able to solve problems) and negative
ability (to reminisce about sad and profound
events) are both significantly associated with psycho-
logical well-being among the elderly (Cappeliez and
O’Rourke, 2006). From evidence-based studies of
reminiscence used to improve psychological well-
being, using the Affect Balance Scale (ABS), Short
Form 36 General Health Survey (SF-36), and the
General Questionnaire (GHQ) it was found that
reminiscence helped people to improve psychological
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
Reminiscence therapy and the institutionalized elderly 381
well-being, with the average ABS score increasing from
1.5–10.9 to 3.2–14.9 ( p < .05) (Fielden, 1990; Haight
and Dias, 1992; Haight et al., 1998; Haight et al., 2000;
Tatchell and Jordan, 2004). Moreover, the positive
effect on mood lasted for 1 year ( p < .05) (Haight
et al., 2000). These studies presented evidence to
suggest that reminiscence therapy is helpful in
improving overall psychological well-being and to
prevent further psychological deterioration.
Evidence-based studies of reminiscence therapy on
treating loneliness
When an elderly person was moved from their private
home to a nursing home, or to a long-term care facility
from home, the person’s feelings of loneliness
increased, compared to those people who remained
at home living in the community (Bondevik and
Skogstad, 1996). Research on the association between
reminiscence and loneliness remains limited, however,
some studies have demonstrated a decrease in the
feeling of loneliness when reminiscence therapy was
provided 1–3 times per week for at least 1 h, occurring
between 10 and 13 sessions. The UCLA Loneliness
Scale was commonly used in these type of studies
(McDougall et al., 1997; Wei, 2004; Liu and Guo,
2007). According to these study results, reminiscence
eased the feeling of loneliness among the elderly,
with the average score of the UCLA Loneliness Scale
dropping from 44.9–54.2 to 35.5–40.4 (p < .05)
(McDougall et al., 1997; Wei, 2004; Liu and Guo,
2007). The findings in data-based studies have been
inconclusive on the therapeutic role of reminiscence
therapy in alleviating loneliness in the elderly persons.
Ethical consideration
The study protocol was approved by Institutional
Review Board of the University for the protection of
human subjects and the consenting nursing home
institution. Before the study began researchers
informed the participants about the topic of the
research, the research objectives, the time needed to
perform the study, and the instruments being used to
collect data. Each participant signed a consent form
that they had been informed about the study and that
they were free to withdraw at any time and their data
would be destroyed. All the participants’ personal
information was held confidential.
Methods
The research team has conducted a series of life review
intervention studies in the elderly population in
Taiwan and has published these findings internation-
ally (Chiang et al., 2008). This study further builds on
these findings. In this study, we used an experimental
design to assign the participants to either the
experimental group (reminiscence group) or the other
waiting list control groups.
Study subjects
We recruited our study samples from a nursing home
institution in the Taipei area. The inclusion criteria
were: (1) conscious and able to speak Mandarin or
Taiwanese, (2) aged 65 years or over, and (3) the
MMSE score was greater than 20. Participants were
excluded from this study if they showed evidence of
significant cognitive impairment.
Measurement tools
We used the following tools to examine the effects of
reminiscence therapy on mood and to determine the
potential confounding variables in the study.
Center for epidemiological studies depression scale
(CES-D)
The CES-D is self-response questionnaire consisting of
20 questions to measure a person’s emotional
performance in the past week. The symptoms asked
about in the CES-D include depression, feelings of
guilt, worthlessness, helplessness, hopelessness, men-
tally induced activity, regression, poor appetite, and
sleep disturbance. The total score ranges from 0 to
60 points, and the level of depression is positively
associated with the score. A score of 16 is the common
cutoff point used, with 0–15 points indicating
no depression, 16–20 points as mild depression, 21–
30 points as moderate depression, and over 30 points
as severe depression. Roberts et al. (1991) performed a
depression screening among high school students
using the CES-D, and the authors found the sensitivity,
specificity, and positive predictive value of the CES-D
was 38%, 76%, and 10%, respectively. The internal
consistency reliability of the screening was 0.77–0.99,
and the 4-week test–retest reliability was 0.67. The
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
382 K.-J. Chiang et al.
relation coefficient for the BDI was 0.81, and it was
0.90 for SDS.
Symptoms checklist-90-R (SCL-90-R)
This checklist was designed by Derogatis as a self-
evaluation checklist, and it was further translated into
Chinese by Yeh. Zheng (1987) recruited a group of
intellectually disabled mothers to test the reliability and
validity of this checklist, and the author further edited
the checklist into one with 35 questions based on the
Chinese version. The score of that checklist ranged
from 0 to 140, with a higher score indicating more
serious psychological well-being problems. The results
from Cheng et al. study indicated that the Cronbach a-
value of the checklist was 0.89–0.92.
Revised University of California Los Angeles
loneliness scale (RULS-V3)
The RULS-V3 measures emotional and social lone-
liness, and it has undergone a three-time modification
based on the ‘‘Loneliness Scale’’ developed by the
University of California, Los Angeles in 1980.
The questionnaire contains 20 questions. The total
score ranges from 20 to 80, with a high score indicating
more severe feelings of loneliness. Regarding its cutoff
points, a score between 20 and 40 indicates mild
loneliness, a score between 41 and 60 indicates
moderate loneliness, and a score between 61 and
80 indicates severe loneliness. This questionnaire can
be applied to young adults, adults, and elders, and the
Cronbach a-value of this questionnaire was tested to
0.89–0.94 (Russell, 1996). Wang et al. (2001) translated
the RULS-V3 into a Chinese version and tested it
among elders in a rural community in Southern
Taiwan, obtaining a Cronbach a-value of the Chinese
version of the questionnaire at 0.82 with a test–retest
reliability of 0.73.
Mini-mental state examination (MMSE)
The MMSE is the most wildly used cognitive
screening instrument for older persons and includes
orientation, registration, attention and calculation,
recall and language (Folstein et al., 1975). The total
score for the MMSE ranges from 0 to 30; scores >24
indicate basically no cognitive impairment; scores 20–
23 indicate mild cognitive impairment; scores 10–19
indicate moderate Alzheimer’s disease; scores 0–9
indicate severe Alzheimer’s disease. The reliability was
adequate with a Cronbach’s a of 0.75. External
construct validity was supported by expected associ-
ations (Lin et al., 2008).
Demographics
The demographic characteristics of participants
included, age, marital status, education level, health
status, economic status, and any other chronic medical
diagnosis (See Table 1).
Study procedure
The data were collected during a one to one interview.
Researchers informed each participant of the study’s
objectives and about reminiscence therapy. Then,
those who consented to participate were randomly
assigned to either the experimental or comparison
(waiting list control) group by permuted block
randomization. Three waves of data collection were
conducted: pre-test, post-test, and 3-month follow-up
tests were performed to examine the effects of the
reminiscence therapy on each of the participants in
the experimental group. We provided reminiscence
therapy to the participants in the experimental
group for 8 weeks. The sessions were structured and
concentrated on a different topic each week. The
therapy topics included (1) sharing memories and
greeting each other; (2) increasing participant aware-
ness of their feelings and helping them to express their
feelings; (3) identifying positive relationships from
their past and how to apply positive aspects of past
relationships to present relationships; (4) recalling
family history and life stories; (5) transition in life
issues; (6) gaining awareness of personal accomplish-
ments and identifying personal goals; (7) identifying
positive strengths and goals; and (8) an overall review
of the eight sessions and then a farewell. Therapy was
held in the recreation room of the facility once a week
in a 90-min session. A master’s prepared student in
mental health nursing with practicum, internship, and
clinical experience with elderly persons and group
reminiscing led all the groups. This enabled a constant
control over leadership variability. A co-leader was
present for each session. The co-leader served as a
reliability check for the measure that was completed on
each participant during the group session. Both group
leaders had extensive experience and training in group
counseling and reminiscence therapy. The primary
investigator provided the training and protocols. The
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
Reminiscence therapy and the institutionalized elderly 383
training consisted of 54 h of didactic training followed
by the reminiscence group therapy manual. The
waiting list control group met to complete the
assessment instruments during the same weeks that
the treatment groups were tested. Written instructions
were followed by researchers to ensure uniform
administration procedures for all groups. Following
the completing of this investigation, subjects in the
waiting list control group participated in other
reminiscence therapy.
Data analysis
SPSS 15.0 and SAS 8.0 statistical packages were used to
construct our database and perform statistical analyses.
Descriptive statistics were performed with percentages,
means, and standard error applied. In addition to
parametric data analysis, non-parametric tests were
also utilized: t-test, Mann–Whitney U-test, and
generalized estimating equation (GEE) were used for
data analysis. GEE was used to explore the effects of the
intervention on the elders’ depression level, loneliness,
and psychological well-being, respectively. GEEs have
become an important strategy and are robust in the
analysis of longitudinal data, in which subjects are
measured at different points in time.
Results
In this study, a participant who missed therapy four
times was considered a dropout. Initially, each
group had 65 participants. In the experimental group,
20 participants dropped out during the study,
representing a dropout rate of 31%. In the comparison
group, 18 participants dropped out, representing a
dropout rate of 28%. The common reasons for leaving
the study were being unable to comply with the therapy
schedule, personal health problems, being hospitalized,
and that the experience was not what the participant
had expected it to be. After excluding the dropouts,
45 participants remained in the experimental group
and 47 were left in the comparison group.
Characteristics of the participants
All of the participants were males with an average
age of 77.24 (SD ¼ 3.97) years (Table 1). Of the
participants, 58% (n ¼ 53) were unmarried, and 55%
Table 1 Characteristics of the study participants
Variable (categorized) Experimental group
(n ¼ 45)
Comparison group
(n ¼ 47)
Pre-test comparison
Number
(average)
%
(SD)
Number
(average)
%
(SD)
Test/value p-Value*
Education level Fisher’s exact test/3.99 0.44
Illiterate 25 55.56 26 55.32
Elementary school 13 28.89 13 27.66
Junior high school 6 13.33 3 6.38
High school 1 2.22 2 4.26
College 0 0 3 6.38
Marital status Fisher’s exact test/1.53 0.71
Married 8 17.78 6 12.77
Widowed 5 11.11 9 19.15
Divorced/separation 6 13.33 5 10.64
Unmarried 26 57.78 27 57.45
Self-perceived health status Fisher’s exact test/2.24 0.55
Very bad 0 0 1 2.13
Bad 13 28.89 17 36.17
Fair 25 55.56 20 42.55
Good 7 15.56 9 19.15
Economic status Fisher’s exact test/0.29 1.00
Enough for daily expenses 26 57.78 28 59.57
Somewhat difficult 18 40 18 38.30
Very difficult 1 2.22 1 2.13
Age 77.42 3.71 77.06 4.23 Mann–Whitney U-test/0.63 0.53
MMSE score 23.02 2.16 23.17 1.81 Mann–Whitney U-test/–0.77 0.44
The number of chronic medical illness 2.42 0.84 2.51 0.80 Mann–Whitney U-test/0.66 0.51
Note:*p < 0.05.
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
384 K.-J. Chiang et al.
(n ¼ 51) of them were illiterate. About half of the
participants (n ¼ 45) perceived their health status as
fair, and 59% (n ¼ 54) of them reported that they had
no economic pressures. The average MMSE score was
23.10 1.98 points. Utilizing the measurement tools,
we examined the participants’ symptoms of depres-
sion, psychological well-being, and feelings of lone-
liness. We then compared the experimental and
comparison groups to examine the effects of the
reminiscence therapy. We also studied how long
the effects of the therapy lasted. From the pre-test, the
symptoms of depression (p ¼ 0.72), psychological
well-being ( p ¼ 0.71), and feeling of loneliness
( p ¼ 0.88) did not differ between groups (Table 2).
The comparisons of the confounding demographic
variables between the baseline data in the experimental
group and the control group, and the result
showed that there was no significant difference in
educational level ( p ¼ 0.44), marital status ( p ¼ 0.71),
self-perceived health status ( p ¼ 0.55), economic status
( p ¼ 1.00), and the number of chronic medical
illnesses ( p ¼ 0.51) (Table 1).
Evaluation of the outcome of the therapy
After the intervention of the reminiscence therapy, the
average depression score in the experimental group
decreased from 19.11 points in the pre-test to 16.18
and 15.49 points after intervention and 3 months
follow-up, respectively. The difference of the depres-
sion status in the post-test and follow-up tests differed
significantly between groups (z ¼7.09, p < 0.0001;
z ¼7.82, p < 0.0001) (Table 3). The average psycho-
logical well-being score fell from 27.09 points to 24.13
and 23.91 points in the experimental group right after
reminiscence therapy and 3 months follow-up, and
psychological well-being in the follow-up tests was
significantly different between groups (z ¼10.25,
p < 0.0001; z ¼10.63, p < 0.0001) (Figure 1). The
average loneliness score declined from 42.24 points to
34.82 and 35 points in the experimental group right
after reminiscence therapy and 3 months follow-up,
indicating that the feeling of loneliness improved
from moderate to mild. And likewise, the difference
in the feeling of loneliness in the follow-up tests
was significant between the groups (z ¼27.26,
p < 0.0001; z ¼22.75, p < 0.0001) (Figure 2).
Table 2 Descriptive statistics data of experimental and comparison groups of depression, psychological well-being, and loneliness
Variable Experimental group (n ¼ 45) Comparison group (n ¼ 47) t-value p-Value*
Mean/SD Mean/SD
Depression
Pre-test 19.11/2.12 18.91/2.98 0.37 0.72
Post-test 16.18/2.07 18.74/2.70
Follow-up test 15.49/1.99 19.43/2.22
Psychological well-being
Pre-test 27.09/1.76 26.91/2.61 0.38 0.71
Post-test 24.13/2.40 27.68/2.30
Follow-up test 23.91/2.10 27.89/2.22
Loneliness
Pre-test 42.24/7.37 42.00/8.04 0.15 0.88
Post-test 34.82/7.05 42.11/7.82
Follow-up test 35.00/7.16 42.09/7.93
Note:*p < 0.05.
Table 3 Generalized estimating equation (GEE) analysis of longitudinal
outcome of the depression (n ¼ 92)
Variable Estimate SE z-value p-Value
Intercept 18.91 0.43 43.92 <0.0001
Group (exp.)
a
0.20 0.47 0.42 0.6776
Time (2nd)
b
0.17 0.14 1.23 0.2205
Time (3rd)
b
0.51 0.29 1.75 0.0798
Group (exp.)
X time (2nd)
c
2.76 0.39 7.09 <0.0001
Group (exp.)
X time (3rd)
c
4.13 0.53 7.82 <0.0001
Note: model: depression ¼ 18.91 þ 0.20 (group) 0.17 (time (2nd))þ 0.51
(time (3rd)) 2.76 (group (exp.) X time (2nd)) 4.13 (group (exp.) X time
(3rd)).
a
Reference group: comparison group.
b
Reference group: time (1st).
c
Reference group: group (comparison) X time (1st).
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
Reminiscence therapy and the institutionalized elderly 385
Discussion
All of the participants in this study were males and
most were illiterate. Half of the study participants were
unmarried, suggesting that they would receive less
support from their Taiwanese families. Additionally,
prior to the study commencing there were few
interactions occurring among the study participants
in this nursing facility. Therefore, most of the
participants felt depressed, hopeless, lonely, and
thought that no one understood or truly cared about
them. Accompanied by the reality of aging, their
mental, and physical status worsened.
Changing of the depressed mood
The study results demonstrate that the reminiscence
therapy successfully improved the participants
depressive symptoms. This finding was consistent
with the results in several previous studies (Ashida,
2000; Haight et al., 2000; Jones, 2003; Wang, 2005,
2007; Beth, 2006).
During reminiscence therapy, at first the partici-
pants passively shared their life experiences with
others. As the internal cohesion gradually developed,
the participants actively began to share their personal
reminiscences and found this activity meaningful.
Participants were reminded that their memories of the
past were very important to the success or otherwise of
the research. This encouragement was aimed at
showing participants that their sharing of life
experiences and memories was valuable. Through
reminiscence, participants recalled their own talents
and values and remembered happy times and stories
from their lives. They shared with others their
accomplished life missions and how they had solved
personal problems during each life stage. Such sharing
of experiences was very well received from the other
participants adding to its value. Through the sharing of
activities, participants realized that every life was
composed of happiness, anger, sadness, and joyfulness,
and that everyone had a unique life journey which was
irreplaceable. The group process of sharing and
praising each other brought cohesion and friendship
to these elderly residents, which significantly improved
their depressive symptoms.
Improvement in the psychological well-being
The study results showed that the reminiscence therapy
helped to improve the elders’ psychological well-being.
This finding was consistent with results from other
studies (Fielden, 1990; Haight and Dias 1992; Haight
et al., 1998; Haight et al., 2000; Tatchell and Jordan,
2004).
Through reminiscence therapy, the participants had
an opportunity to share their emotions, which further
brought peace to them. The understanding that
everyone had been living a meaningful life that was
filled with happiness, sorrow, and contentment made
the participants feel satisfied and proud of themselves.
During reminiscence and interactive feedback, the
participants were experiencing a self-improvement
process, this improving their psychological well-being.
This outcome supports the finding that reminiscence
therapy may be a defense mechanism for elderly
people, since it is ego strengthening and dissonance
reducing. With the use of reminiscence therapy as a
form of interaction within groups, elderly individuals
may be able to improve their psychological well-being
and that of others.
Improvement in the feeling of lonelines s
The study has shown that reminiscence therapy is
helpful in improving the elderly participants’ feelings
Figure 1 Generalized estimating equation (GEE) analysis of longitudinal
outcome of the psychological well-being (n ¼ 92). Note: model: psycho-
logical well-being ¼ 26.91 þ 0.18 (group) þ 0.77 (time (2nd)) þ 0.98
(time (3rd)) 3.72 (group (exp.) X time (2nd)) 4.15 (group (exp.) X
time (3rd)).
Figure 2 GEE analysis of longitudinal outcome of loneliness (n ¼ 92).
Note: model: loneliness ¼ 42 þ 0.4 (group) þ 0.11 (time (2nd)) þ 0.09
(time (3rd)) 7.48 (group (exp.) X time (2nd)) 7.22 (group (exp.) X
time (3rd)).
Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 380–388.
386 K.-J. Chiang et al.
of loneliness. This finding also correlates with previous
findings (McDougall et al., 1997; Wei, 2004; Liu and
Guo, 2007).
The study gave the participants a chance to interact
with people rather than remaining alone for the whole
time. The sharing and positive feedback among
participants’ stimulated friendships and a greater
personal understanding for each other, giving them
a sense of belonging to a group and acceptance by the
group. By learning about others’ lives, the participants
realized that every life was unique and interesting, even
if there were some sad or frustrated stories. The group
therapy built a strong sense of belonging and cohesion
among participants that helped to ease feelings of
loneliness. The results further indicate that reminis-
cence can help ease the pain of isolation and loneliness.
Memory is used as a therapeutic intervention to help
validate a sense of self.
Conclusion
This study has demonstrated the positive short-term
effect (3 months follow-up) of reminiscence therapy
on depression, psychological well-being, and loneliness
among institutionalized elderly male. The reminis-
cence therapy proved successful among these elders
because it alleviated depression, improved their
psychological well-being, and eased their feelings
of loneliness. The limitations of this study include:
(1) it was almost completely restricted to elderly
from one institution; (2) subjects limited in their
ability to comprehend the information about the
study; (3) the control group was restricted to waiting
list control; (4) there was approximately a 30%
dropout rate. Therefore, there exist threats to validity
and generalizing the results to a broad population.
Results should be regarded tentatively but with positive
interest. It is suggested that future research can apply
this study to other elderly populations, include a
rigorous control, and expand the enrollment to both
males and females.
Nevertheless, in light of the study results, we suggest
that healthcare workers provide appropriate reminis-
cent activities in long-term caring institutions based on
the characteristics of their elderly residents because
these activities could improve their psychological
well-being. In addition, researchers could develop a
measuring tool that suits the conditions in Taiwan to
examine the overall psychological well-being among
institutionalized elderly people. Future studies could
examine the long-term effects of reminiscence therapy,
as this study was limited to a 3-month follow-up
examination.
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    • "The effectiveness of simple reminiscence evidence is limited with regard to its effects on mental health (Westerhof et al., 2010). Several research findings point to the positive effects of reminiscence in reducing depressive symptoms (Bohlmeijer, Valenkamp, Westerhof, Smit, & Cuijpers, 2005; Chiang et al., 2010; Kwon, Cho, & Lee, 2013; Pinquart & Forstmeier, 2012; Shellman, Mokel, & Hewitt, 2009; Stinson, Young, Kirk, & Walker, 2010), improving cognition (Cotelli, Manenti, & Zanetti, 2012; Kwon et al., 2013; Pinquart & Forstmeier, 2012; Woods, Spector, & Jones, 2005), mood (Cotelli et al., 2012; Lin, Dai, & Hwang, 2003; Woods et al., 2005), quality of life (Kwon et al., 2013), satisfaction with life (Chiang, Lu, Chu, Chang, & Chou, 2008; Lin et al., 2003), self-esteem (Chao et al., 2006; Chiang et al., 2008), well-being (Chiang et al., 2010; Pinquart & Forstmeier, 2012; ReisBergan, Gibbons, Gerrard, & Ybema, 2000), mastery (Bohlmeijer et al., 2005; Bohlmeijer, Kramer, Smit, Onrust, & Van Marwijk, 2009; Pinquart & Forstmeier, 2012), ego integrity, purpose in life, preparation for death, mental health and social integration (Pinquart & Forstmeier, 2012). Nevertheless, despite the potential beneficial of reminiscence therapy, authors are unanimous in recognizing constraints, particularly in methodological designs, that hampers an effective assessment of the impact of this therapy (Cotelli et al., 2012; Lin et al., 2003; Lopes, Afonso, & Ribeiro, 2014; Pinquart & Forstmeier, 2012; Westerhof et al., 2010; Woods et al., 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: Working with past memories through reminiscence interventions has been practiced for several decades with successful outcomes on mental health in older adults. Few studies however have focused on autobiographical memory recall in older individuals with cognitive impairment. This study aims to analyze the impact of an individual reminiscence program in a group of older persons with cognitive decline living in nursing homes on the dimensions of cognition, autobiographical memory, mood, behavior and anxiety. A two-group pre-test and post-test design with single blinded assessment was conducted. Forty-one participants were randomized to an experimental group (n = 20) and a control group (n = 21). The first group attended five weekly individual reminiscence sessions. Changes in the outcome measures were examined for cognition (Montreal Cognitive Assessment; Autobiographical Memory Test), behavior (Alzheimer Disease Assessment Subscale Non-Cog) and emotional status (Cornell Scale for Depression in Dementia; Geriatric Depression Scale, and Geriatric Anxiety Inventory). Participants attending reminiscence sessions exhibited better outcomes compared to the control group in cognition, anxiety and depression (p<0.001), and presented a higher number of retrieved autobiographical events, specificity of evoked memories and positive valence of events (p<0.001), and also presented lower latency time for recalling events, and lower negative recalled events (p<0.01). This study supports the potential value of reminiscence therapy in improving the recall of autobiographical memory. Reminiscence therapy can be helpful to maintain or improve cognitive function, decrease anxiety and manage depressive symptoms and altered behavior, but further investigation is needed to clarify long-term effects.
    Article · Jun 2016
    • "It is highly rated by caregivers and participants [19]. Also, it has been shown to be a promising intervention for improving the sense of integrity and ameliorate depression in people with dementia [10, 8, 19]. In reminiscence therapy, participants are encouraged to reflect on past experiences with the aid of familiar stimuli from the past, like photographs. "
    Full-text · Conference Paper · Jan 2016 · Quality of Life Research
    • "Of the five included studies, one found no significant difference in social isolation pre-to post-intervention [69, 70], and one did not specifically measure this outcome, despite having the objective to reduce social isolation [67]. The remaining three studies reported reducing social isolation [66, 68, 71]. Two of these three studies, however, found no significant reduction in depression [9, 71]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: A systematic review was undertaken of studies reporting interventions for reducing social isolation and depression in older people receiving aged care services (community or residential). Methods: Gray literature and relevant electronic databases were systematically searched for studies published in English between January 2009 and December 2013. Two reviewers independently screened studies for selection using predetermined inclusion and exclusion criteria and independently completed methodological quality review at study level. Studies of poor methodological quality were excluded. Data were extracted at study level by one reviewer and independently checked by a second reviewer, using a standardized form. The results across studies were qualitatively synthesized with outcomes described and summarized at last follow-up. Results: Although the original objective was to review rural studies, no intervention studies based in rural areas met criteria for inclusion in the review, and only urban studies could be reviewed. Of 403 articles, six articles representing five studies with moderate-to-low risk of bias were included for review. All study participants were older adults ranging in age from 77 to 86 years. All studies had small sample sizes, ranging from 26 to 113 participants. Three of the five included intervention studies successfully reduced social isolation; one also successfully reduced depression. Conclusions: Only one intervention, group-based reminiscence therapy, was reported as successful in reducing both social isolation and depression in older people within an urban aged care setting. More research is needed to explore transferability of interventions across different aged care settings and into rural areas.
    Full-text · Article · Dec 2015
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