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The Effect of Reminiscence Therapy on Cognition, Depression, and Activities of Daily Living for Patients With Alzheimer Disease

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DOI: 10.1177/0891988715598233 · Source: PubMed
Abstract
The purpose of this study was, conducted with experimental design, to investigate the effect of reminiscence therapy on cognition, depression, activities of daily living of institutionalized mild and moderate Alzheimer patients. The study was conducted with a total of 62 patients (31 intervention group and 31 control group) in four home care in Ankara, Turkey. Study was done between the July 1, 2013 and December 20, 2014. Reminiscence therapy sessions were held with groups consists of 4-5 patients, once a week with 30-35 minute duration for 12 weeks. Standardized Mini Mental Test was used in sample selection. Patients were listed through their mini mental test scores, and randomized as odd numbers to control group and even numbers to intervention group. Data were collected with forms developed by researcher 'Data Sheet' and 'Activities of Daily Living Follow-up Form' as well as scales 'Standardized Mini Mental Test' and 'Geriatric Depression Scale'. Chi-square, Mann Whitney-U test, variance analyses in repeated measures and Bonferroni tests were used for analysis. The increase in mean Standardized Mini Mental Test score and the decrease in mean Geriatric Depression Scale score of the individuals in the intervention group compared to the control group at the end of the reminiscence therapy was statistically significant (P < 0.05). At the end of reminiscence therapy sessions, increase in cognition and decrease in depression were found statistically significant in intervention group. © The Author(s) 2015.
Article
The Effect of Reminiscence Therapy
on Cognition, Depression, and Activities
of Daily Living for Patients With
Alzheimer Disease
Gu
¨
ler Duru As¸iret
1,2
, and Sevgisun Kapucu
1,2
Abstract
The purpose of this study was, conducted with experimental design, to investigate the effect of reminiscence therapy on cognition,
depression, activities of daily living of institutionalized mild and moderate Alzheimer patients. The study was conducted with a
total of 62 patients (31 intervention group and 31 control group) in four home care in Ankara, Turkey. Study was done between
the July 1, 2013 and December 20, 2014. Reminiscence therapy sessions were held with groups consists of 4-5 patients, once a
week with 30-35 minute duration for 12 weeks. Standardized Mini Mental Test was used in sample selection. Patients were listed
through their mini mental test scores, and randomized as odd numbers to control group and even numbers to intervention group.
Data were collected with forms developed by researcher ‘Data Sheet’ and ‘Activities of Daily Living Follow-up Form’ as well as
scales ‘Standardized Mini Mental Test’ and ‘Geriatric Depression Scale’. Chi-square, Mann Whitney-U test, variance analyses in
repeated measures and Bonferroni tests were used for analysis. The increase in mean Standardized Mini Mental Test score and
the decrease in mean Geriatric Depression Scale score of the individuals in the intervention group compared to the control group
at the end of the reminiscence therapy was statistically significant (P < 0.05). At the end of reminiscence therapy sessions, increase
in cognition and decrease in depression were found statistically significant in intervention group.
Keywords
Alzheimer disease, elderly, cognitive testing, depression
Introduction
Alzheimer disease (AD) together with cognitive decline causes
various neuropsychiatric and behavioral problems in activities
of daily living, resulting in serious physical and psychological
destruction in the elderly patients.
1
Advancing AD causes the
patients to need continuous care. They may also lose the ability
to recognize themselves, close family members, and caretakers
or to feed themselves and walk without help, and they may
become fully bedridden.
2
Pharmacological and nonpharmacological methods are used
in the treatment of such symptoms in AD. Nonpharmacological
interventions that have no side effects and slow disease progres-
sion are currently becoming increasingly important as an addition
to pharmacological treatment.
3
Nonpharmacological applications
are patient centered and geared toward supporting the individuals
rather than forcing them or focusing on their deficiencies.
4
Remi-
niscence therapy is the most commonly used nonpharmacological
application in AD and other types of dementia.
5-8
Reminiscence is defined as the individual remembering
a past event, verbally or nonverbally, alone or with a group.
7
Reminiscence was defined by Burnside and Haight as ‘‘the pro-
cess of remembering long-forgotten experiences and events
that are worth remembering for the person’ (p.587) based on
its dictionary meaning.
9
Stinson states that the Nursing Inter-
ventions Classification (NIC) System describes reminiscence
therapy as an intervention based on remembering the events
experienced in the past in order to increase the adaptation to the
present time, quality of life, and satisfaction from the institution
of institutionalized individuals. According to the NIC, reminis-
cence therapy is largely derived from the nursing information
system, care plan manuals, and nursing books. Reminiscence
therapy is among the independent functions of nurses recom-
mended by NIC and it is emphasized that it should be among
the care applications provided in the institutions where elderly
people live.
10
1
Aksaray University Health High School, Aksaray University, Aksaray, Turkey
2
Faculty of Nursing, Hacettepe University, Ankara, Turkey
Received 12/26/2014. Received revised 6/15/2015. Accepted 6/17/2015.
Corresponding Author:
Gu¨ler Duru As¸iret, Aksaray University Health High School, Aksaray University,
Street Zafer, Aksaray 68100, Turkey.
Email: gulerduru@gmail.com
Journal of Geriatric Psychiatry
and Neurology
2016, Vol. 29(1) 31-37
ª The Author(s) 2015
Reprints and permission:
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DOI: 10.1177/0891988715598233
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Reminiscence therapy has been used since the early 1960s
and toward the end of this period has taken the form of sharing
the activities, events, and experiences in the past with other
individuals in the group and others, usually with the help of
an old music, voice recording, photograph, and other familiar
elements, and in the form of individual or group therapy by nur-
sing professionals.
8
Its use in or outside institutions, especially
by geriatric nurses, social workers, occupational therapists, and
psychologists became widespread in the 1980s.
11
Reminiscence therapy is also used in emergency depart-
ments, day care nursing homes, long-term care homes, hospi-
tals, and the houses of the individuals in addition to nursing
homes.
9
Studies from the 1990 to 2015 period have reported
using reminiscence therapy for 6 to 12 weeks as 1 to 2 sessions
lasting 30 to 60 minutes each per week.
5,12-18
The most positive
results were reported with sessions performed in groups of 6 to
10 elderly people living in an institution, providing sufficient
time for each individual in this groups.
9,12
It is suggested that
reminiscence therapy be conducted with positive memories
during the session.
10,14
Each session should have a specific
subject. The last session should be the closing session with a
general summarization and evaluation.
10
According to the literature, reminiscence groups are most
commonly formed with patients having dementia living in nur-
sing homes.
6
Reminiscence therapy has been found to decrease
depressive emotions
13,19,20
and feeling of loneliness,
5
and to
increase psychological well-being,
20,21
life satisfaction,
8,20
and
communication.
5
Additionally, reminiscence therapy was
found to increase the cognitive level
22,23
and social activities
24
and have a positive effect on daily living activities.
23
The aim of our study was to make a positive change in the
daily living activities of patients with AD by providing a pos-
itive effect on the cognitive status and depression level with
reminiscence therapy. Other aims were to increase the knowl-
edge of nurses on the application of reminiscence therapy as it
has many benefits and ensuring more common use of this ther-
apy among the nursing applications in our country. This study
was performed to investigate the effect of reminiscence therapy
on the cognitive status, depression, and daily living activities of
institutionalized patients with mild and moderate AD.
Method
Study Design
The study was conducted in a quasi-experimental post hoc
manner to investigate the effect of reminiscence therapy on the
cognitive status, depression, and daily living activities of insti-
tutionalized patients with mild and moderate AD. The study
took place in 4 Ministry of Family and Social Policies elderly
care and rehabilitation centers in Ankara, Turkey, between July
1 and December 20, 2013.
Participants
The following criteria were used for selecting the sample of the
study:
Aged 65 years and above and has a diagnosis of AD,
the standardized Mini-Mental State Examination
(MMSE) test cognitive levels score is 10 to 24 points,
will be staying at the institution for at least 3 months for
regular attendance at the therapy sessions, and
has no obstacle regarding talking and communication
that would prevent active participation in group interac-
tions and volunteers to participate in the study.
We did not include participants with an MMSE result above
24 or below 10 in the study sample. We first obtained the lists
of participants aged 65 years and above with a diagnosis of AD
from the institution’s records. We then administered MMSE
according to the educational level of the participants in the list.
The third stage included sorting the participants who met the
sampling criteria according to the MMSE score range (18–23
points and 10–17 points) and gender. The experiment and con-
trol groups were created from this final list with odd numbers
making up the control group and even numbers the intervention
group.
The study sample was calculated using power analysis. It
was determined that a minimum of 17 participants should be
included in the study at the level of 90% power and 5% type
I error to find a significant 2.8 points decrease in the depression
scale score of the intervention group compared to the control
group at the end of the reminiscence therapy. Considering the
losses that could be experienced during the research process
and the statistical significance of the tests, a total of 66 individ-
uals were included in the sample with 33 in the intervention
group and 33 in the control group. One participant was
excluded from the sample due to death, 2 had to undergo treat-
ment in intensive care, and 1 developed a speech problem
because of stroke. The study was completed with a total of
62 individuals consisting of 31 participants each in the inter-
vention and control groups.
Measures
The study data were gathered with face-to-face interviews using
the Geriatric Depression Scale (GDS) and Standardized MMSE
test in addition to a Descriptive Information Form and Daily Liv-
ing Activities Observation Form prepared by the investigator.
The administration of the forms took about 60 minutes.
The Descriptive Information Form consisted of a total of
38 questions, 14 open and 24 close-ended. The Descriptive
Information Form included questions on the demographic char-
acteristics of the individuals, their medical characteristics, daily
living activities, and living in the institution.
The Daily Living Activities Observation Form was prepared
by the investigator after reviewing the literature as the scales
used for the evaluation of daily living activities in our country
were not appropriate for institutionalized individuals. This
form was prepared by obtaining the opinions of 5 specialists
on the participant during the preparation process. The Daily
Living Activities Observation Form was used to evaluate the
mobility, hygiene, nutrition, sleep, dressing, establishing and
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maintaining communication, willingness to collaborate, socia-
lization, and restlessness status of the individual. The daily liv-
ing activities of the individuals were entered into the Daily
Living Activities Observation Form by getting help from the
people who took care of the elderly person. This form was
administered to the individuals in both groups by the investiga-
tor as both a preliminary test and a final test. The scores
obtained by the individuals in this form were converted to per-
centages and evaluated.
The Standardized MMSE was developed by Folstein et al to
evaluate cognitive deficiencies and includes 5 main topics as
recording memory, attention, calculation, remembering, and
language with a total of 11 items.
25
The MMSE appropriate
to the educational status of the individuals was administered
by the investigator to the individuals in both groups in both the
preliminary and final tests.
The GDS was developed by Yesavage et al and its validity
and reliability tests have been performed.
26
This scale developed
for the elderly patients consists of a total of 30 questions with
‘yes’ or ‘‘no’’ answers. Each answer in favor of depression has
a value of one point, and the other answers have a value of zero
points. The score is evaluated as no depression for 0 to 11 points,
possible depression for 12 to 14 points, and definite depression
for over 14 points. The GDS was administered to the individuals
in both groups as both preliminary and final tests by the investi-
gators in our study.
Procedures
The individuals included in the study after MMSE application
were interviewed with the face-to-face technique and the GDS,
Descriptive Information Form, and Daily Living Activities
Observation Form were administered in the preliminary test.
The MMSE, GDS, and Daily Living Activities Observation
Form were administered at the final test. For individuals who
could not participate in the reminiscence therapy sessions due
to an excuse, a makeup session was held for the participant at
the end of the 12-week study.
In order to ethically prevent interaction between the groups,
a conversation lasting 20 to 25 minutes on average per week
was held with the individuals in the control group with tea or
coffee and the participants and duration varied by week. The
conversation topic could be the religious or official special
days in the relevant week, the health of the individuals, or cur-
rent issues. No questions regarding remembering the past were
asked to the individuals in these sessions.
The dates suitable for the individuals in the intervention
group were determined, and a 12-week meeting schedule was
prepared. The days or hours when the individuals regularly vis-
ited health care institutions and the hours when their visitors
came to see them were taken into account when preparing this
schedule. The individuals were told by the investigator that reg-
ular participation in the sessions would affect the result when
the meeting schedule was being prepared. The reminiscence
therapy sessions were started on August 8, 2014 and ended
on December 20, 2014.
Reminiscence therapy has been performed in the form of
1 to 2 sessions per week for a total of 6 to 12 weeks, each last-
ing 30 to 60 minutes in the literature. The reminiscence therapy
was applied in the form of sessions lasting a total of 12 weeks
and 30 to 45 minutes in the form of having conversation about
1 participant each week, once a week in our study. Considering
that the individuals within the scope of the study had mild or
moderate AD and were aged 65 years and above, we made sure
that there would be 2 to 5 individuals in a session. Individuals
of the same gender were put together when creating the groups.
We made sure positive memories were shared, as suggested.
Session subjects included introduction, childhood and family
life, school days, starting work and work life (for housewives,
a day spent at home), a day of fun outside the home, marriage,
plants and animals, infants and children, food and cooking,
holidays and travel, and celebrations, followed by session eva-
luation and closure.
6,27-29
Old objects and pictures of old
objects were taken to the institution by the investigator to facil-
itate remembering of the weekly subjects and pictures belonging
to the individuals were requested from the study participants
when possible. Weekly sessions performed within the scope of
the study were held in the meeting room and the library that the
elderly individuals could easily access.
Tea and coffee were offered to the individuals before start-
ing the reminiscence therapy sessions. The sessions were first
started by asking how the individuals had spent their previous
week. After showing the objects appropriate for the subject of
the week to facilitate remembering, the individuals were asked
to share the events and experiences they remembered with the
group. Each individual was given time to think and an addi-
tional time was also provided to think by changing the speaking
order if requested. Issues shared in the sessions were summar-
ized at the end of each session, the subject of the next week was
announced, and the session was completed. The experiences or
events remembered by the individuals were noted by the inves-
tigator at each session.
The individual directing the group plays an important role in
managing reminiscence therapy properly. This person has to be
a good leader and also needs to manage time well, develop pro-
fessional relationship with the group members, give them equal
opportunity to speak, and ensure an environment that is based
on interaction and sharing. The leader also needs to help the
group members to form a connection between the past and the
present day based on what they remember during the reminis-
cence sessions.
Data Analysis
The statistical analysis of the study data was performed using
the IBM SPSS for Windows Version 21.0 (SPSS Inc. Chicago,
Illinois) package program. Numerical variables were summar-
ized with mean + standard deviation and median (minimum
maximum) values in the analysis of the data. Categorical
variables were shown with numbers and percentages. Before
making the intergroup and within-group comparisons for numer-
ical variables, the parametric test assumptions (normality,
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homogeneity of variance, and sphericity) were checked. The
presence of a difference between the intervention and control
groups in terms of categorical variables was investigated with
the chi-square test. The effect of the demographic characteristics
of the intervention and control groups on the scale scores was
evaluated with the Mann-Whitney U test. Within-time and inter-
group differences in terms of scale scores were examined with
the variance analysis in repeating measurements. Pairwise com-
parisons were performed with the Bonferroni test. The signifi-
cance level was accepted as P < .05. The independent
variables of the study included the information obtained during
reminiscence therapy and the descriptive information form of the
individuals such as age, gender, educational status, and duration
of institutionalization. The dependent variables of the study were
the MMSE, GDS, and Daily Living Activities Observation
Form.
Ethical Considerations
Written permission for the study to be conducted was obtained
from the Governorship of Ankara Provincial Directorate of
Family and Social Policies and from Hacettepe University
Noninterventional Clinical Research Ethics Committee (GO
13/356). All patients gave written consent after receiving both
an oral and written explanation of the study’s objectives and
procedures.
Results
The mean age of the individuals who participated in the study
was 82.1 + 4.9, and 67.7% were female. The educational sta-
tus of 66.1% was primary school and lower, 95.2% were sin-
gle, 72.6% had been employed previously, 75.8% had a
history of 4 or fewer chronic diseases, 54.8% needed help for
daily living activities, and the mean living duration in the
homecarewas6.5+ 5.3 years. The difference between the
descriptive features of the individuals in the intervention and
control groups was found to be statistically insignificant (P >
.05; Table 1).
The increase in mean MMSE score of the individuals in the
intervention group compared to the control group at the end of
the reminiscence therapy was found to be statistically signifi-
cant (P < .05). Although not stated in the table, the differences
between mean MMSE scores of the individuals in the interven-
tion group by disease stage was found to be statistically insig-
nificant (P > .05). The decrease in mean GDS score of the
individuals in the intervention group compared to the control
group at the end of the reminiscence therapy was statistically
significant (P < .05; Table 2).
The score difference medians of the individuals in both
groups for mobility, individual hygiene, feeding, sleeping, and
dressing parts of the Daily Living Activities Observation Form
before and after the reminiscence therapy revealed no change
Table 1. Characteristics of the Study Participants.
Variable
Experimental Group (n ¼ 31) Control Group (n ¼ 31) Pretest Comparison
Test/P Value
a
n (%) n (%)
Age (years) +SD 81.83 + 4.87 82.26 + 5.07
65-79 age 8 (25.8) 9 (29.0) w
2
¼ 0.000
80 and above 23 (74.2) 22 (71.0) P
a
¼ 1.000
Gender
Female 21 (67.7) 21 (67.7) w
2
¼ 0.000
Male 10 (32.3) 10 (32.3) P ¼ 1.000
Education level
Elementary education and 19 (61.3) 22 (71.0) w
2
¼ 0.288
High school and above 12 (38.7) 9 (29.0) P ¼ 0.591
Marital status
Married 0 (0.0) 3 (9.7)
Unmarried 31 (100.0) 28 (90.3) P
b
¼ 0.238
Employed status previously
Worked 23 (74.2) 22 (71.0) w
2
¼ 0.00
Have not worked 8 (25.8) 9 (29.0) P ¼ 1.000
Number of chronic diseases excluding Alzheimer disease
1-4 23 (74.2) 24 (77.4) w
2
¼ 0.000
5 and above 8 (25.8) 7 (22.6) P
a
¼ 1.000
Needed help status for daily living activities
Yes 13 (41.9) 21 (67.7) w
2
¼ 3.191
No 18 (58.1) 10 (32.3) P
a
¼ 0.074
Living duration in the home care
0-5 Years 15 (48.4) 16 (51.6) w
2
¼ 0.00
6 Years and above 16 (51.6) 15 (48.4) P
a
¼ 1.000
Abbreviation: SD, standard deviation.
a
P < .05.
b
Fisher exact test values is given to w
2
value could not be given.
34 Journal of Geriatric Psychiatry and Neurology 29(1)
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between the groups. A positive change was found in the com-
munication, collaboration, socialization, and restlessness parts
of the Daily Living Activities Observation Form in the inter-
vention group. The score difference median for the communi-
cation part of the Daily Living Activities Observation Form
was found to increase 33.3% at the end of the application in
the intervention group compared to the preapplication state.
Although there was no change in the score difference median
of the intervention and control groups for the collaboration and
socialization parts of the Daily Living Activities Observation
Form, an increase of 33.3% was found in the intervention group
scores after treatment. There was a decrease of 33.3% in the
minimum restlessness score of the intervention group and
a decrease of 33.3% in the median restlessness score of the con-
trol group (Table 3).
Discussion
The Effect of Reminiscence Therapy on the Cognitive
Status of Individuals
The MMSE mean score of the individuals in the intervention
group was found to show a statistically significant increase com-
pared to the individuals in the control group at the end of remi-
niscence therapy in our study (P < .05; Table 2). Thorgrimsen
et al reported a positive effect of reminiscence therapy on cogni-
tive functions in a study they conducted with patients having
dementia.
23
Wang found a significant increase in the MMSE
score of individuals who underwent reminiscence therapy in a
study conducted with individuals in 5 elderly care institution
in Taiwan.
30
Similarly, Van Bogaert et al found a significant
increase in the MMSE scores of individuals at the end of remi-
niscence therapy in a study where they examined the effect of
individual reminiscence therapy on patients with mild and mod-
erate stage AD.
22
The same study found a greater increase in the
MMSE scores of patients with moderate stage AD compared to
those in the mild stage at the end of reminiscence therapy. The
difference between the MMSE mean scores of the individuals
in the intervention group by disease stage was statistically insig-
nificant (P > .05) in our study in contrast to the previous study.
We believe that applications supporting remembering the past at
regular intervals in elderly individuals positively affects the cog-
nitive process as the individuals make a conscious effort and
spend more time to remember past events while the memories
of another person stimulate the memories of the individual dur-
ing the sessions and facilitate reminiscence.
The Effect of Reminiscence Therapy on Depression
A decrease of 6.29 units was found in the GDS score of the
individuals in the intervention group at the end of reminiscence
therapy in our study (P < .05; Table 2). Our results are similar
to other studies where the effect of reminiscence therapy on
depression was investigated. Chiang et al reported a decrease
in loneliness and depression levels and an increase in the psy-
chological well-being of the individuals in the group where
reminiscence therapy was used in a study they conducted with
institutionalized individuals aged 65 years and above.
5
Chueh
and Chang reported a decrease in depressive symptoms at
the end of the therapy period in a study where they monitored
institutionalized male participants aged 65 years and above for
6 months following therapy for 4 weeks.
19
Serrani Azcurra
reported a significant decrease in depression in the reminiscence
therapy group in a study where the effect of reminiscence ther-
apy on the quality of life of patients with AD staying at a nursing
home was evaluated.
15
Similarly, Van Bogaert et al reported a
significant decrease in the depression score of individuals fol-
lowing reminiscence therapy in a study they conducted with
patients having AD.
22
Melendez-Moral et al reported decreased
depressive symptoms and a positive change in life satisfaction,
self-esteem, and psychological well-being of individuals who
underwent reminiscence therapy in a study they conducted with
institutionalized elderly participants.
20
Youssef found decreased
Table 3. Descriptive Statistics Data of Experimental and Control
Groups of Activities of Daily Living.
Activities of
Daily Living
Experimental
Group (n ¼ 31)
Control Group
(n ¼ 31)
Median (min–max) Median (min–max)
Mobility Pretest 100 (0–100) 100 (33.3–100)
Posttest 100 (0–100) 100 (33.3–100)
Individual hygiene Pretest 100 (33.3–100) 100 (33.3–100)
Posttest 100 (33.3–100) 100 (33.3–100)
Feeding Pretest 100 (33.3–100) 100 (33.3–100)
Posttest 100 (33.3–100) 100 (33.3–100)
Sleeping Pretest 100 (0–100) 100 (0–100)
Posttest 100 (0–100) 100 (0–100)
Dressing Pretest 100 (33.3–100) 66.7 (33.3–100)
Posttest 100 (33.3–100) 66.7 (33.3–100)
Communication Pretest 33.3 (0–100) 33.3 (0–100)
Posttest 66.7 (33.3–100) 33.3 (0–100)
Collaboration Pretest 66.7 (0–100) 33.3 (0–100)
Posttest 66.7 (33.3–100) 33.3 (0–100)
Socialization Pretest 66.7 (33.3–100) 66.7 (33.3–66.7)
Posttest 66.7 (66.7–100) 66.7 (0–100)
Restlessness Pretest 100 (66.7–100) 100 (66.7–100)
Posttest 100 (0–100) 66.7 (33.3–66.7)
Table 2. Descriptive Statistics Data of Experimental and Control
Groups of MMSE and GDS.
Variable
Experimental
Group (n ¼ 31)
Control Group
(n ¼ 31)
T Value, P Value
a,b
X + SD X + SD
MMSE
Pretest 15.65 + 2.49 14.16 + 2.14 F ¼ 22.418, P < .001
Posttest 18.54 + 3.36 14.35 + 1.99
GDS
Pretest 15.61 + 3.06 15.93 + 4.35 F ¼ 30.518, P < .001
Posttest 9.32 + 2.82 14.35 + 4.66
Abbreviations: MMSE, Mini-Mental State Examination; GDS, Geriatric
Depression Scale; SD, standard deviation.
a
Variance analysis in repeating measurements was used.
b
P < 0.05.
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depression scores following reminiscence therapy in females
aged 65 to 74 years while no change was found in the group
aged 75 years and above.
12
However, some studies report no
effect of reminiscence therapy on depression.
13,31,32
The
decrease in depressive findings is thought to be due to factors
such as increased communication of the individuals with each
other, the individuals being able to talk without being criti-
cized, allocating time to the participants regularly, the develop-
ment of the notion of belonging to a group, remembering
past events, increased confidence following such reminiscence,
and the weekly sessions providing a regular schedule for the
person.
The Effect of Reminiscence Therapy on the Daily Living
Activities of the Individuals
While no change was found in the score difference medians of
the intervention group for the motility, individual hygiene, eat-
ing, sleeping, and dressing areas of daily living activities, a
positive change was found in communication, collaboration,
socialization, and restlessness (Table 3). Lai et al found that
reminiscence therapy had no effect on the daily living activity
of individuals in a study they conducted on patients with
dementia staying at a nursing home.
16
Similarly, a positive
effect of reminiscence therapy on daily living activities was not
found in a study conducted by Serrani Azcurra with patients
having AD living in a nursing home.
15
Thorgrimsen et al found
that the behavior and daily living activities of individuals in the
intervention group had changed positively compared to those in
the control group at the end of reminiscence therapy in a study
they conducted in individuals with dementia.
23
This difference
between the study results is thought to be due to factors such as
the various stages and durations of AD, the number of addi-
tional chronic diseases, and the level of physical dependence
of the participants.
The score difference medians for daily living activities in
the communication area of individuals in our intervention
group were found to increase 33.3% as a result of the therapy
(Table 3). Head et al found that the communication with insti-
tution staff of the individuals in the group where reminiscence
therapy was administered had increased at the end of the ther-
apy in a study.
33
Chiang et al found an increase in the commu-
nication and self-confidence and a decrease in loneliness of
institutionalized individuals at the end of reminiscence therapy
in their study.
5
Thorgrimsen et al found that the communication
of the individuals in the intervention group had increased com-
pared to the individuals in the control group in a study they con-
ducted with patients having v.
23
We believe that the increase in
the communication of the individuals noted in our study similar
to the studies conducted could be due to factors such as an
appropriate environment that ensures the individual prepares
a weekly program, gets prepared for the sessions, shares emo-
tions, and becomes a member of a group, together with the
opportunity to socialize provided by the group.
Although there was no change in the score difference med-
ians of the individuals in either the intervention or control
group in the collaboration and socialization areas of daily liv-
ing activities at the end of reminiscence therapy, an increase
of 33.3% was found in the minimum scores of the intervention
group. Reminiscence therapy is reported to increase participa-
tion in social activities, well-being, satisfaction, and cognitive
stimulation.
7
Reminiscence therapy was found to have a posi-
tive effect on the socializing of the individuals in a study
conducted by Cook with 54 institutionalized individuals.
32
Jonsdottir et al found that reminiscence therapy had a positive
effect on the socialization and well-being of individuals in a
study they conducted on final stage of patients with lung dis-
ease.
31
Serrani Azcurra reported a positive increase in social
collaboration and quality of life in a group where reminiscence
therapy was used in their study on the effect of reminiscence
therapy on the quality of life in patients with AD staying at a
nursing home.
15
Sivis¸ and Demir reported that the activities
performed with the group as a result of reminiscence therapy
application to elderly people living in an institution facilitated
developing positive relationships between the individuals and
making new friends and affected their social life positively.
24
The result of the study are similar to the literature and include
a positive change both in communication and socialization as a
result of the individuals getting the opportunity to know each
other by participating regularly in the sessions, discovering
their common life experiences through sharing, and gradually
feeling that they belong to a group.
Conclusion
We found reminiscence therapy to have a beneficial effect on
the cognitive status and depression in institutionalized patients
with mild and moderate AD in our study. Reminiscence ther-
apy had a positive effect on communication but a limited effect
on collaboration, socialization, and restlessness. The positive
effect of reminiscence therapy on the cognitive status, depres-
sion, and daily living activities in institutionalized patients with
mild and moderate AD indicates a need for more widespread
use of reminiscence therapy and training health care staff and
especially nurses to support such activities, while the limited
effect on daily living activities indicates the need to establish
programs supporting any activities the individual cannot per-
form while developing those that can be performed. We also
recommend studies on larger samples and also on patients with
chronic diseases other than AD.
Limitations and Strengths
The limitations of this study include having been performed in
4 institutions in Ankara and not including patients with AD
from other institutions and the lack of periodic follow-up fol-
lowing the reminiscence therapy.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
36 Journal of Geriatric Psychiatry and Neurology 29(1)
at Aksaray Universitesi on December 13, 2015jgp.sagepub.comDownloaded from
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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