Effects of Reminiscence Therapy and Activities for Elderly People With Dementia - Coursework Example

Insert Introduction and Purpose ment 75% of current dementia cases are caused by Alzheimer’s disease. The other notableforms of dementia include vascular dementia, Lewy body dementia, frontotemporal dementia, progressive supranuclear palsy, normal pressure hydrocephalus, corticobasal degeneration and Cruetzfeldt-Jacobson disease. The number of dementia cases globally as at 2010 was approximated at 35.6 million. These numbers increase considerably with age as dementia affects roughly 5% of the population past 65 and 20-40% of those older than 85. Approximately 65% of those with dementia live in low and middle income nations where further alarming increases in dementia are forecasted. The rates are slightly higher in women than men at ages 65 and greater (Klever, 78). Surveys suggest the possibility of a healthy lifestyle (comprising good nutrition, adequate exercise and sound social relations) significantly reducing the risks of developing dementia in old age. However, there isn’t a single prophylactic (drug or lifestyle choice) that prevents the onset of dementia. Healthcare focus has therefore been to ensure that dementia patients get access to care and support including a reduction in the use of psychoactive medication where possible. One of the most suitable alternatives to drugs in the treatment of dementia cases has been the use of reminiscence therapy. This paper delves, in detail, various aspects of this important therapy. Reminiscence Therapy Reminiscence therapy, commonly applied on elderly dementia patients, basically describes the use of life histories, in at least once a week sessions, to improve the psychological well-being of patients. These life histories can either be in written form, oral form, or both. The therapy respects the life and experiences of the individual and only uses them to elicit/ maintain sound mental status. Reminiscence therapy has been suggested to improve affect and coping skills using various psychological functions such as boredom reduction, bitterness revival, preparation for death, conversation, problem solving, intimacy maintenance, identity and to teach/ inform (Klever, 90). Reminiscence therapy therefore depends on the patient having an intact autobiographical memory. It is the volitional/ non-volitional biographic intervention/ process of recollecting past memories. The degree of effectiveness of the therapy solely relies on how important the memories being recalled are to the patient. There are different means of practitioners/ caregivers ensuring that memory recalled is important to the patient such as by asking questions which suggest the importance of the event and even using historical materials from the patient’s past (Schweitzer, 801). Reminiscence involves exchanging memories with the old and young, friends and relatives, with caregivers and professionals, passing on information, wisdom, and skills. It is about giving the patient a sense of value, belonging, importance, peace and power. It can be conducted anywhere, be it in homes or in therapeutic settings purposed for the same. In a care facility or a profession set-up, the inclusion of friends and relatives during reminiscence therapy can provide irreplaceable results. These people can provide photos and recall events in the patient’s life that may evoke full attention. They can also be vital in pointing out subjects that the patient finds discomforting, distressing or upsetting and that warrant increased support (Klever, 124). Reminiscence can be intrapersonal or interpersonal. While intrapersonal reminiscence takes a cognitive stance and takes place individually, interpersonal reminiscence on the other hand assumes more of a conversational dimension and is a group-based therapy. Likewise, reminiscence can be information, evaluation or obsessive. Information reminiscence can be applied on an individual who lacks concern about his/ her life and relations. It is commonly applied to enable one enjoy retelling stories from their past and find something to be happy about from such memories. Evaluative reminiscence, practiced in group sessions, entails retelling memories throughout one’s life and then sharing with others in the group. Obsessive therapy on the other hand is applied in attempts to move an individual to let go of any negative emotion that may be lingering from the past and consequently enable them be at peace with themselves (Schweitzer, 846). The structure of reminiscence therapy can vary greatly from one session to another, but psychologists find two types of therapies that have shown higher levels of effectiveness – integrative reminiscence therapy and instrumental reminiscence therapy. In integrative reminiscence, patients attempt to embrace the negative happenings of the past, resolve past conflicts, reconcile on matters left pending and pursue meaning and purpose of existence. In this form of therapy, individuals review both bad and good experiences throughout their lives and in the end cultivate a more realistic and adaptive view of the self that induces both negative and positive characters (Schweitzer, 901). Instrumental therapy uses recollection of past coping activities and strategies (where a person acted effectively to control their environments) to elicit a positive impact on the patient’s self esteem and efficacy. This form of therapy is particularly suitable and effective for the elderly who may be unable to do what they were once capable of doing (Joyce, 345). Presently, there exist three main theories of reminiscence – disengagement theory, ego-integrity theory and continuity theory. The disengagement theory emphasizes on the patient withdrawing from social responsibilities with this movement away from social life aimed at preparing patients for quick changes concerned with the end of life. The theory aims at removing the fear of death from patients and empowering them to meet their death with zest and joy. The ego-integrity theory however is based on the patient having some sense of fulfillment and success when looking back at their life and accomplishments. In a successful ego-integrity implementation, the patient is at peace with him/ her-self and is open to the eventuality of death. While both the disengagement theory and the ego-integrity theory offer the elderly a chance to embrace death as an inevitable reality, continuity theory on the other hand allows an individual to order and interpret the changes in their lives and hence attain a sense of continuity in the inner psychological characteristics and in social behavior and social circumstances (Oleary and Nicola, 159). Depending on the aim of the treatment, reminiscence therapy may occur in groups, pairs or individually and can either be structured or unstructured. Individual needs determine whether therapy is done in groups or individually with the purpose of reminiscence being to improve cognitive memory components and encourage either intrapersonal or interpersonal development. Prompts/ mediums/ stimuli such as photographs, video recordings, household items, music, movies, slides, painting pictures, looking at objects of autobiographical meaning, smell or taste (using smell kits, for example and different foods that the patient may have enjoyed in early years), touching objects, feeling textures, pottery, and other personal recordings become so vital in the process of reminiscence therapy (Oleary and Nicola, 163). Reminiscence is predominantly used among the elderly dementia (patients who often suffer socially and emotionally) population to provide a sense of continuity in one’s life and help alleviate depression, behavioral, social and cognitive problems amongst others. Research and survey strongly indicate that group reminiscence therapy sessions result in stronger social relationships and friendships within the groups. For instance, in a community experiencing high suicide rates, a group of researchers introduced reminiscence therapy among the elderly population with overwhelming findings/ views afterwards. Questionnaires revealed that 98.7% of the participants enjoyed listening to one another, 97.3% enjoyed the experience of talking, 89.2% appreciated the positive impact of reminiscence in their daily lives and another 92.6% expressed their desire to continue with the program. There appeared in almost all cases increased life satisfaction and self-esteem after the therapy. In another survey, a group of elderly veterans undergoing one session a week of reminiscence therapy for 12 weeks in Taiwan experienced considerable increases in self-esteem and life satisfaction unlike the control group who hadn’t been through any sessions (Joyce, 365). Some researchers say that these improvements after reminiscence are basically a doing of increased coping skills, mainly via assimilative and accommodative coping. Assimilative coping is said to change life circumstances so that it is in agreement with one’s choices and goals and thereby helps one follow their personal objectives even in the face of hardship. Accommodative coping on the other hand serves to assist patients restructure their objectives to accommodate hardships by reviewing values and priorities, developing new meaning from the circumstance and potentially transforming personal identity. Other coping mechanisms facilitated through reminiscence therapy are said to include emotion focused coping and problem focused coping. Emotion focused coping basically helps the patient distance themselves from a stressful circumstance by not being too serious about it or by considering the positives of the stress such as personal growth and accepting responsibility for one’s own role in creating the stress. Problem focused coping steers the individual to change the circumstance with an analytic approach to solve the problem. In the clinically depressed older adults, reminiscence therapy has been shown to be a very effective way of reducing depression and thus improving participant’s affect. Reminiscence in older adults is thus useful as a way of refreshing better memories, reducing boredom and preparing for the eventuality of death. Researchers note that even those participants who had previously been reminiscing in negative ways make good candidates for reminiscence therapy as they appear more comfortable with the process. Researchers also see reminiscence being useful in fighting depression in cancer and leprosy patients. There have been especially improved cognitive function and a general improvement in the quality of life with emphasis on improved emotions and overall happiness/ mood for elderly dementia patients. In a 2007 study involving 102 elderly dementia patients with the aim of determining the effect of reminiscence on both cognitive and affective functions, established scales were used in a pre- and post-test self-report design. The Geriatric Depression Scale short form (GDS-SF) was used to determine the affective functions of dementia patients and determine their personal opinion on their state of well-being while the Mini-Mental State Examination (MMSE) was used to determine cognitive functions. To determine how the caregivers felt the patients were doing emotionally, the Cornel Scale for Depression in Dementia (CSDD) was used ((Brody and Vicki, 312). The results were encouraging with considerably improved scores in both MMSE and CSDD scores pre to post-test indicating positive effects of reminiscence therapy on both cognitive and emotional function for the demented elderly. To determine whether it is actually the type of therapy (reminiscence) or just the increase in social interactions that elicited the improvements, a study was conducted in 2008. An experimental group treated with reminiscence therapy was weighed against a control group which participated in group conversations on everyday issues. The MMSE was used to evaluate the participants’ pre and post-test cognitive and affect functions of both groups while the Todai-Shiki Observational Rating Scale (TORS) was employed to evaluate the participants’ mood, quality of daily living, and interest in sessions. The results in cognition indicated more words recalled from the reminiscence group than the control conversation group indicating that it is the actual reminiscing therapy which results in positive cognitive effect and not just any other conversation with peers. The reminiscence group also exhibited higher scores after the sessions in both TORS and Daycare Evaluation Table Scores than the control demonstrating that the reminiscing group was, in the end, happier, had more improved quality of daily life and was more focused on treatment ((Brody and Vicki, 413). In similar studies, patients with Alzheimer’s disease, after undergoing reminiscence have been shown to withdraw less and interact more with others, that is, improvement of withdrawal, than they were before the therapies. And similar results have been observed with elderly vascular dementia patients, that is, improved withdrawal and cognitive function compared to the control after therapy, in a 6-month follow-up. However, for patients with Alzheimer’s, improvements in withdrawal were no longer seen after 6 months following the halting of the therapy and therefore sustained intervention (reminiscence therapy) is advised/ prudent. In addition, patients undergoing reminiscence therapy were shown to exhibit considerably higher well-being than those who had been in either the goal-directed group activity or unstructured free time. A case study of an 86-year old Alzheimer’s male patient undergoing individual reminiscence therapy yielded improved cognitive functioning (Joyce, 400). The effects (outcomes) of reminiscence therapy can be evaluated in a plethora of ways. However, the most co0mmonly used features while measuring the outcome of reminiscence therapy on patients include depressive symptoms, psychological well-being, meaning/ purpose in life, cognitive performance, ego-integrity, mastery and social interactions. Neuro-imaging to determine the outcome of therapy is particularly useful for patients with vascular dementia to ascertain increase in cortical glucose metabolism in bilateral anterior cingulate and in the left inferior temporal lobe (which are respectively useful for social interaction and remote memories). In addition, patients with Alzheimer’s elicit increased blood flow to the frontal lobe of the brain after reminiscence therapy which often disintegrates in patients with the disease. This is in addition to the positive alterations in evaluated behavioral characteristics after therapy (Bornat, 377). In as much as it is agreed from observations that there are positive outcomes of reminiscence therapy, the degrees of outcomes differ. These differences are a consequence of several factors such as the form of the reminiscence therapy, the format of the sessions (for example, whether in group or individual settings), number of sessions completed, the health, age and gender of the patient, residence of the patient and whether the patient had experienced any events that led to significant changes in their lives. Surveys indicate that life-review therapies have much higher positive impacts on the psychological well-being of the patient compared to other simple reminiscence therapies. This is thought to be the case because of the increased organization of the method and purpose (goal) of the therapy. Life-review typically involves individual sessions in which the person is guided chronologically through life experiences, encouraged to evaluate them and may produce a life history book. Levels of improvement in behavior appear to vary depending on whether reminiscence was conducted on individual basis, or in small or large groups (Webster and Barbara, 665). Although improvements are seen across all depression levels, those exhibiting higher depression levels showed a greater rate of improvement of symptoms compared to those with less depressive symptoms before onset of the therapy. Improvements in depression occur in both females and males following reminiscence therapy and current information on the method do not indicate that there is a relationship between the type of community a patient lives in during the time of the therapy and the role of the therapy. In addition, those who experienced various major life events showed improved mental stability including a decrease in depressive symptoms and anxiety (Bornat, 411). Conclusion Reminiscence therapy is an inexpensive and beneficial technique of aiding the elderly dementia patients in successful aging and happy living. It appears to offer a sense of overall life satisfaction and coping skills as well as improving depressive symptoms, psychological symptoms and well-being, ego-integrity, meaning/ purpose in life, mastery, cognitive performance, social integration and preparation for death. There are moreover, improved self-esteems, increased social involvement, lower loneliness levels and alienation. At a follow up depression, other indicators of mental health, well-being, ego-integrity, cognitive performance and death preparation remained improved from pre-treatment (Webster and Barbara, 772). However, every patient has the right to decline reminiscence therapy and activity. The whole process hinges on upholding the integrity and respect of the patient and therefore patients are allowed the right to refuse any involvement in reminiscence. Although one can encourage them to accept therapy sessions, their refusal is valid, for self-protection, privacy, autonomy and power. Ensuring that care staffs have information about the patient (including their likes and dislikes) and not just their diagnosis is critical during reminiscence therapy (Bornat, 418). Implications on Healthcare (a continuation of the Conclusion) A successful reminiscence not only allows the patient to express their moods but also enables the nursing personnel to deliver person-centered care. If effective reminiscence therapy programs are to be used even more for treatment of dementia, there is the inevitable need for the value of the technique to be fully comprehended especially by the care staff and then the therapy endorsed by those in managerial positions. This is so as many practitioners continue to express concerns that theses psychological types of therapy involving discussions and talking are often ridiculed by other sections of the medical staff and even the extended society as ‘not real work’. This is even as many more people hold that depression in older people is quite normal even when evidence indicates that this depression can be dealt with using reminiscence therapy (Brody and Vicki, 425). Reminiscence therapy also eases the strain felt by caregivers and relatives of dementia patients with its effects on the patients and allows the healthcare staff to see beyond the diagnosis while facilitating communication between the persons with dementia and their families (Bornat, 469). Works Cited Bornat, Joanna. Reminiscence reviewed: evaluations, achievements, perspectives. Balmoor, Buckingham [England: Open University Press, 1994. Print, 377, 411, 418, 469 Brody, Claire M., and Vicki Granet Semel. Strategies for therapy with the elderly living with hope and meaning. 2nd ed. New York, NY: Springer Pub. Co., 2006. Print, 312, 413, 425 Joyce, Chris. "City Memories: Reminiscence as creative therapy." Quality in Ageing and Older Adults 6.4 (2005): 34-41. Print, 345, 365, 400 Klever, Sandy. "Reminiscence therapy." Nursing 43.4 (2013): 36-37. Print 78, 90, 124 Oleary, Eleanor , and Nicola Barry. "Reminiscence therapy with older adults." Journal of Social Work Practice 12.2 (2010): 159-165. http://www.informaworld.com/smpp/title~content=713436417. Web. 30 Jan. 2013. Schweitzer, Pam. Reminiscence theatre making theatre from memories. London: Jessica Kingsley Publishers, 2007. Print, 801, 846, 905 Webster, Jeffrey D., and Barbara K. Haight. Critical advances in reminiscence work from theory to application. New York: Springer, 2002. Print, 665, 772 Read More