The effects of reminiscence on psychological well-being in older adults: a meta-analysis

Management of pain in individuals with spinal cord injury: Guideline of the German-Speaking Medical Society for Spinal Cord Injury

Introduction: Pain is a prominent complication in spinal cord injury (SCI). It can either occur as a direct or as an indirect consequence of SCI and it often heavily influences the quality of life of affected individuals. In SCI, nociceptive and neuropathic pain can equally emerge at the same time above or below the level of injury. Thus, classification and grading of pain is frequently difficult. Effective treatment of SCI-related pain in general and of neuropathic pain in particular is challenging. Current treatment options are sparse and their evidence is considered to be limited. Considering these aspects, a clinical practice guideline was developed as basis for an optimized, comprehensive and standardized pain management in SCI-related pain.

Methods: The German-Speaking Medical Society for Spinal Cord Injury (Deutschsprachige Medizinische Gesellschaft für Paraplegiologie – DMGP) developed a clinical practice guideline that received consensus from seven further German-speaking medical societies and one patient organization. The evidence base from clinical trials and meta-analyses was summarized and subjected to a structured consensus-process in accordance with the regulations of the Association of Scientific Medical Societies in Germany (AWMF) and the methodological requirements of the “German instrument for methodological guideline appraisal”.

Results: This consensus-based guideline (S2k classification according to the AWMF guidance manual and rules) resulted in seven on-topic statements and 17 specific recommendations relevant to the classification, assessment and therapy of pain directly or indirectly caused by SCI. Recommended therapeutic approaches comprise pharmacological (e.g. nonsteroidal anti-inflammatory drugs or anticonvulsants) and non-pharmacological (e.g. physical activity or psychotherapeutic techniques) strategies for both nociceptive and neuropathic pain.

Discussion: Assessment of SCI-related pain is standardized and respective methods in terms of examination, classification and grading of pain are already in use and validated in German language. In contrast, valid, evidence-based and efficient therapeutic options are limited and ask for further clinical studies, ideally randomized controlled trials and meta-analyses.

Using a Reminiscence-based Approach to Investigate the Cognitive Reserve of a Healthy Aging Population

Objectives: The concept of Cognitive Reserve (CR) has been used to account for brain plasticity in older adults that may underlie the resilience against the effects of aging or pathology on cognitive abilities. This study aims at exploring the proxies of CR in a sample of healthy older adults by analyzing their spontaneous reminiscence through a discourse analysis approach. Method: Fifteen community-dwelling older adults were asked to participate in a video-recorded, spontaneous reminiscence interview. Interviews were transcribed according to Conversation Analysis, and two judges classified the interview content identifying five main markers of CR: enriched environment, cognitively stimulating activities, education, physical activity, and social interaction. Results: Reminiscence allowed to identify markers of CR. Sharing stories that are linked to CR markers promote positive emotion, coherent sense of self, and cognitive evaluation of the importance of the social network. Conclusions: Reminisce looks like a possible approach not only to indirect evaluate the CR, but also to promote it. Clinical Implications: The reminisce approach can be used as a clinical tool to assess and increase the CR, help the clinical population to experience more positive emotions, maintain a more defined sense of self, and value more the social resources available.

Increasing the social participation of older rural residents: Opportunities offered by "OPTEACH"

PROBLEM

The issues addressed in this article are two-fold. Firstly, education about ageing is predominantly textbook-based. Secondly, many rural older people face social isolation which impacts their health. In addressing the first issue, we discovered that our project, Older Persons Teaching and Empowering Aged Care Students (OPTEACH), has the potential to have a positive impact on the second issue.

DESIGN

We run university education sessions involving older people. Since such sessions present unique challenges, we obtained a grant to develop resources to assist educators and support rural older people to become "OPTEACHers."

SETTING

OPTEACH was undertaken in several rural communities in New South Wales and included staff and residents at residential aged care facilities and community-dwelling rural older people.

KEY MEASURES FOR IMPROVEMENT

Our previous work had highlighted a need for educator resources that would facilitate "ageing" being taught in a way that both involved and respected older people. Our ethos centres on the "co-creation" of knowledge, and having older peoples' unique contributions recognised and celebrated.

STRATEGIES FOR CHANGE

Resources to assist with planning and being involved in OPTEACH education sessions are available at www.opteach.com.au. They will support a growing community of "OPTEACHers," with beneficial flow-on effects for rural older people.

EFFECTS OF CHANGE

We seek to provide practical support to both educators and older people to provide "real life" education on the experience of ageing.

NEXT STEPS

Further evaluation is needed, yet we anticipate a positive impact on self-esteem, community "connectedness" and quality of life for older rural "OPTEACHers" as the approach gains momentum.

Loss in the Life Story: Remembering Death and Illness Across Adulthood

The experience of loss has not often been studied in the life story literature. Life disruption when loss of a loved one occurs may make loss events distinct, even from other challenges, when recalled. Optimally, individuals incorporate such events into their life story in a way that allows them to reflect positively on their life overall. We suggest that telling narratives that represent loss as leading to personal growth or as highlighting one’s connectedness to others may allow a positive view of life overall. In contrast, ruminating may signal a lack of meaningful integration of the event. The current study investigates personal growth from, communion in, and rumination about memories of past loss events. It also determines how these factors relate to positive reflection on one’s life overall. Age was explored as a moderator of these relations. Participants (29 younger adults, 40 older adults) narrated an autobiographical loss event and, for comparison, a non-loss challenging life event and a neutral event. Narratives were self-rated for rumination and extent of resultant personal growth, and reliably content-coded for themes of communion. Participants also completed a measure of positive reflection on their life. Loss narratives resulted in more personal growth and contained more communion themes than other challenging or neutral events. Greater loss-related personal growth predicted more positive life reflection for younger adults. How individuals recall and incorporate loss into their life story may relate differentially to psychosocial outcomes in different life phases.

Facilitating Family Life Review during a Relocation to Assisted Living: Exploring Contextual Impact on Family Adjustment

OBJECTIVES

The purpose of this study was to explore how contextual aspects of participants' lives before and throughout relocation to assisted living (ALF) informed family experience of family life review (FLR).

METHOD

Fourteen families participated in a single FLR session within 6 months of the older adults' relocation. Semi-structured interviews, conducted one-month following the FLR session, were analyzed using the constant comparative method. Demographic and relational variables provided context for assessing how individual and family dynamics influenced the family relocation process.

RESULTS

Techniques were used during the three phases of FLR (introduction, validation, consolidation) to encourage openness and mutual dialogue between family members. Health-related limitations challenged older adults' understanding and openness during the FLR. Mental health concerns linked to older adults' outlook on life, comfort in conversation during the FLR, and reflection of lifelong social ties. Family involvement and dynamics influenced how families communicated about their mutual narrative and the relocation transition.

CONCLUSION

FLR is an adaptable intervention to assist older adults and their family during a transition to ALF. Although contextual challenges impacted how families experienced the FLR, they enjoyed FLR as a unifying event that promoted mutual understanding.

CLINICAL IMPLICATIONS

The use of FLR facilitates enhanced understanding and communication during relocation. Older adults' health status as well as family dynamics need to be assessed prior to organizing a FLR to accommodate each families' unique needs.

A Temperament-Attachment-Mentalization-Based (TAM) Theory of Personality and Its Disorders

Theories of personality and its disorders need, from time to time, to be revised and updated according to new empirical and conceptual developments. Such development has taken place in the realms of affective neuroscience, evolution, and social cognition. In this article, we outline a new personality theory, which claims that phenomena we usually ascribe to the concept personality are best understood by postulating a web consisting of three major constituents: temperament (mainly primary emotions), attachment, and self-consciousness (mentalizing). We describe these constituents, their neurobiological underpinnings, the subjective experiences they evoke, and their behavioral implications. We discuss the relevance of the espoused theory in the field of personality disorders with references to borderline, narcissistic, and avoidant personality disorders as well as the DSM-5 alternative model. Implications for social psychology, psychotherapy, and common sense self-understanding are outlined. The theory aims to bridge previous contradictions between natural sciences and hermeneutics by its propositions of the evolution of self-consciousness.

Benchmarks for Evaluating Life Review and Reminiscence Therapy in Alleviating Depression among Older Adults

The efficacy of reminiscence and life review (LR) therapy in alleviating depression among older adults is well established. However, providers in nonresearch settings might implement these interventions inadequately, and such settings rarely can evaluate their outcomes using control groups. Alternatively, evaluators in such settings can calculate a within-group effect size and then compare it with average within-group effect size benchmarks derived from the randomized clinical trials (RCTs) supporting the intervention's effectiveness. This study developed these within-group effect size benchmarks. A search of RCTs from five systematic reviews and meta-analyses, and more recent RCTs published through 2016, yielded 25 studies that met inclusion criteria. Hedge's g for LR recipients and waitlist controls were .598 and -.20, respectively, and .568 and -.012 for reminiscence theory. These benchmarks offer an approach for evaluating the implementation of LR and reminiscence therapy when control groups are infeasible.

Enhancing Meaning when Facing Later Life Losses

OBJECTIVE

This article presents several client cases to illustrate psychotherapeutic interventions for helping older adults facing later life losses enhance their sense of meaning.

METHODS

Cases are derived from the client population of a community mental health clinic which provides psychotherapy for low income, seriously mentally ill, culturally diverse older adults, many of whom experience serious medical illnesses. Over the course of 24 years in this setting, the primary author has observed various interventions which offer possibilities to provide hope and meaning for clients with severe problems.

RESULTS

Interventions discussed with individual cases include utilizing life review and reminiscence therapies, helping in grappling with the ending of life, facilitating enhanced relationships, encouraging creative endeavors, enabling spiritual and religious practices, honoring wisdom and legacy leaving, and engaging in mindfulness practices. Each approach is reviewed with reference to empirical support, clinical utility, and treatment considerations.

CONCLUSIONS

Helping older adults to find hope and meaning in their lives can be challenging. Specific interventions which target meaning-making may be adapted to fit each client's needs.

CLINICAL IMPLICATIONS

Clinicians may focus on enhancing meaning as a core or adjunct aspect of treatment with older adult clients. Considerations for implementing interventions may depend on contextual factors relevant to each case.

The effect of reminiscence therapy on quality of life, attitudes to ageing, and depressive symptoms in institutionalized elderly adults with cognitive impairment: A quasi-experimental study

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi-experimental pretest/post-test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL-BREF, WHOQOL-OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults' quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long-term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.

[A pilot study into person-centred use of photo's in the communication with people with dementia]

Social contact is important for the wellbeing of people. Dementia can complicate social interaction. In two randomized controlled pilot studies, it was investigated whether viewing different types of images together affects the mood and social interaction of people with moderately severe to severe Alzheimer's dementia residing in nursing homes. At the first intervention participants in the experimental group (n = 10) were shown portraits with positive facial expressions, and the participants in the control group (n = 10) were shown portraits with a neutral facial expression. During the second intervention, the experimental group (n = 10) were shown personalized photos and the control group (n = 10) non-personalized photos. There were no statistically significant differences in mood and the degree of social interaction between the groups. However, calculation of the effect sizes showed that there was a tendency for more positive behavior in viewing neutral portraits and that personalized images had a more positive impact on social interaction, negative behavior, speech and mood.

Digitising the wisdom of our elders: connectedness through digital storytelling

Digital storytelling provides older adults with an opportunity to become digital producers, connect with others through story and explore their life history. The authors report on the results of a digital storytelling project for older adults. The study investigated the experiences and perceived benefits of older adults who created digital stories during a ten-week course and explored the reactions of story viewers to the digital stories they viewed during a special sharing event. Eighty-eight older adult participants in Metro Vancouver who attended one of 13 courses offered were included in the study. Most of the participants were female and over half were immigrants. Results from the focus group interviews demonstrated a rich array of reported social and emotional benefits experienced through the process of creating a digital story within the course. Three main themes emerged: social connectedness through shared experience and story, reminiscence and reflecting on life, and creating a legacy. Viewers who attended a ‘Sharing Our Stories’ event reported that the stories were meaningful, well constructed and invoked a range of emotions. The researchers conclude that digital storytelling may help digital storytellers increase connectedness to others and to self. Additionally, this connectedness may extend over time through the process of examining the past to create a digital story that can serve as a legacy to connect to future generations.

The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and meta-analysis

BACKGROUND

Although positive psychology interventions (PPIs) show beneficial effects on mental health in non-clinical populations, the current literature is inconclusive regarding its effectiveness in clinical settings. We aimed to examine the effects of PPIs on well-being (primary outcome), depression, anxiety, and stress (secondary outcomes) in clinical samples with psychiatric or somatic disorders.

METHODS

A systematic review and meta-analysis was conducted following PRISMA guidelines. PsycINFO, PubMed, and Scopus were searched for controlled studies of PPIs in clinical samples between Jan 1, 1998 and May 31, 2017. Methodological quality of each study was rated. We used Hedges' adjusted g to calculate effect sizes and pooled results using random-effect models.

RESULTS

Thirty studies were included, representing 1864 patients with clinical disorders. At post-intervention, PPIs showed significant, small effect sizes for well-being (Hedges' g = 0.24) and depression (g = 0.23) compared to control conditions when omitting outliers. Significant moderate improvements were observed for anxiety (g = 0.36). Effect sizes for stress were not significant. Follow-up effects (8-12 weeks), when available, yielded similar effect sizes. Quality of the studies was low to moderate.

CONCLUSION

These findings indicate that PPIs, wherein the focus is on eliciting positive feelings, cognitions or behaviors, not only have the potential to improve well-being, but can also reduce distress in populations with clinical disorders. Given the growing interest for PPIs in clinical settings, more high quality research is warranted as to determine the effectiveness of PPIs in clinical samples.

TRIAL REGISTRATION

PROSPERO CRD42016037451.

Does life story work improve psychosocial well-being for older adults in the community? A quasi-experimental study

Background

Previous studies have demonstrated that life story work has positive effects when used on older adults. This study aimed to examine the effect of life story work on the general mental well-being, self-esteem, and life satisfaction of older adults by comparing two groups – one with and one without depressive symptoms.

Methods

A quasi-experimental design was adopted in this study. One hundred and twenty-three adults aged 60 or above were recruited from community centers through convenience sampling. They were allocated into two groups based on their level of depressive symptomatology as measured by the Geriatric Depression Scale (GDS). The intervention was to produce a written life story with pictures and memorabilia in four to six semi-structured sessions facilitated by trained volunteers. The outcome measures included general mental well-being (General Health Questionnaire, GHQ), life satisfaction (Life Satisfaction Scale Index A, LSI-A), and self-esteem (Rosenberg’s Self-esteem Scale, RSES). Data were collected at baseline (T0), immediately post-intervention (T1), and at the 3-month follow-up (T2). Generalized estimating equations were used to examine the effect of the intervention on the outcomes.

Results

There was a significant interaction effect between the two groups at T1 (β = 0.244, p < 0.05) with improvements in the GHQ observed in the group with depressive symptomology. No significant time and interaction effects were seen on the LSI-A and RSES. The Friedman test was also used to examine whether the intervention itself would have any effects on the GDS score, with two groups combined. A reduction in the mean GDS score was found to be close to reaching a level of significance (χ² = 5.912, p = 0.052).

Conclusion

The findings of this study provided some preliminary evidence that life story work was effective at improving the general mental well-being of community-dwelling older adults with depressive symptomology. Because older adults with different levels of depressive symptoms might respond differently to life story work interventions, our findings offer interesting directions for future studies – for instance, on what population would benefit the most from Life Story Work and what would be the mechanism that renders Life Story Work effective.

Overgeneral autobiographical memory and depression in older adults: a systematic review

OBJECTIVES

Overgeneral autobiographical memory (OGM) is a well-researched phenomenon in working age adults with depression. However, the relevance and importance of OGM in older adult depression is not well established. The aim of this review was to synthesise existing literature on OGM and depressive symptoms in older adults under the framework of the Capture and Rumination, Functional Avoidance and Impaired Executive Control (CaR-FA-X) model.

METHOD

Literature searches were conducted using PsychINFO, PubMed and Web of Knowledge. Eighteen articles were reviewed.

RESULTS

OGM is elevated in healthy older adults compared to adults of working age, and further elevated in older adults with depression. Evidence supports the role of impaired executive function as a mechanism for OGM in older adults with depression, but no studies measured other components of the CaR-FA-X model (i.e. functional avoidance and rumination).

CONCLUSION

OGM is prevalent in older adults and more so for those with depression; however, there is no clear understanding of the underpinning mechanisms. It is recommended that future research looks at the role of functional avoidance and rumination, and at the use of memory specificity interventions being developed in the working age adult literature.

Measurement of Well-Being in Gerontopsychiatric Nursing Home Residents: Development of the Laurens Well-Being Inventory for Gerontopsychiatry

BACKGROUND

The gerontopsychiatric population consists of nursing home residents with combined psychiatric and physical disabilities. A validated measure to assess well-being among this population is currently not available. This article is a first step toward the development of a well-being instrument for the gerontopsychiatric population.

METHODS

Potential measurement items were gathered and selected with the help of both gerontopsychiatric residents and care professionals. A total of 295 residents and their primary professional caregivers were interviewed. Theoretical and data-driven considerations were applied in the methodological process of scale construction.

RESULTS

The final instrument comprised of 30 items within 3 dimensions of well-being (physical, social, and psychological well-being). Reliability and validity were found to be adequate for all dimensions and subscales.

CONCLUSIONS

The Laurens Well-Being Inventory for Gerontopsychiatry measures well-being in gerontopsychiatric nursing home residents. The first results regarding reliability and validity are promising. More research is needed especially to examine test-retest reliability and responsiveness to change.

Effectiveness of instrumental reminiscence intervention on improving coping in healthy older adults

Reminiscence is a psychological intervention that uses the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, and adjustment to present life. The main goal of this study was to investigate the effect of a reminiscence intervention programme on coping strategies. One hundred fifty healthy older adults attended the reminiscence sessions. In order to evaluate the effects of the programme and find out if its effects lasted over time, we used an experimental design with pretest, posttest, and follow-up assessments, comparing a control group to the intervention group. Repeated-measures analysis of variance showed significant differences in problem-solving coping, positive reappraisal, social support seeking, and avoidance coping with the treatment group obtaining higher scores than the control group in all cases. The effects declined after 3 months, but some differences were found in the treatment group obtaining higher scores in problem-solving coping and positive reappraisal and lower in overt emotional expression. The study suggests that reminiscence therapy contributes to mental health by enhancing coping strategies that can allow the elderly to cope successfully and overcome psychological distress.

Reminiscence therapy for dementia

BACKGROUND

This updated Cochrane Review of reminiscence therapy (RT) for dementia was first published in 1998, and last updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. RT is implemented widely in a range of settings using a variety of formats.

OBJECTIVES

To assess the effects of RT on people living with dementia and their carers, taking into account differences in its implementation, including setting (care home, community) and modality (group, individual).

SEARCH METHODS

We searched ALOIS (the Cochrane Dementia and Cognitive Improvement Group's Specialized Register) on 6 April 2017 using the search term 'reminiscence.'

SELECTION CRITERIA

We included all randomised controlled trials of RT for dementia in which the duration of the intervention was at least four weeks (or six sessions) and that had a 'no treatment' or passive control group. Outcomes of interest were quality of life (QoL), cognition, communication, behaviour, mood and carer outcomes.

DATA COLLECTION AND ANALYSIS

Two authors (LOP and EF) independently extracted data and assessed risk of bias. Where necessary, we contacted study authors for additional information. We pooled data from all sufficiently similar studies reporting on each outcome. We undertook subgroup analysis by setting (community versus care home) and by modality (individual versus group). We used GRADE methods to assess the overall quality of evidence for each outcome.

MAIN RESULTS

We included 22 studies involving 1972 people with dementia. Meta-analyses included data from 16 studies (1749 participants). Apart from six studies with risk of selection bias, the overall risk of bias in the studies was low.Overall, moderate quality evidence indicated RT did not have an important effect on QoL immediately after the intervention period compared with no treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) -0.12 to 0.33; I² = 59%; 8 studies; 1060 participants). Inconsistency between studies mainly related to the study setting. There was probably a slight benefit in favour of RT in care homes post-treatment (SMD 0.46, 95% CI 0.18 to 0.75; 3 studies; 193 participants), but little or no difference in QoL in community settings (867 participants from five studies).For cognitive measures, there was high quality evidence for a very small benefit, of doubtful clinical importance, associated with reminiscence at the end of treatment (SMD 0.11, 95% CI 0.00 to 0.23; 14 studies; 1219 participants), but little or no difference at longer-term follow-up. There was a probable slight improvement for individual reminiscence and for care homes when analysed separately, but little or no difference for community settings or for group studies. Nine studies included the widely used Mini-Mental State Examination (MMSE) as a cognitive measure, and, on this scale, there was high quality evidence for an improvement at the end of treatment (mean difference (MD) 1.87 points, 95% CI 0.54 to 3.20; 437 participants). There was a similar effect at longer-term follow-up, but the quality of evidence for this analysis was low (1.8 points, 95% CI -0.06 to 3.65).For communication measures, there may have been a benefit of RT at the end of treatment (SMD -0.51 points, 95% CI -0.97 to -0.05; I² = 62%; negative scores indicated improvement; 6 studies; 249 participants), but there was inconsistency between studies, related to the RT modality. At follow-up, there was probably a slight benefit of RT (SMD -0.49 points, 95% CI -0.77 to -0.21; 4 studies; 204 participants). Effects were uncertain for individual RT, with very low quality evidence available. For reminiscence groups, evidence of moderate quality indicated a probable slight benefit immediately (SMD -0.39, 95% CI -0.71 to -0.06; 4 studies; 153 participants), and at later follow-up. Community participants probably benefited at end of treatment and follow-up. For care home participants, the results were inconsistent between studies and, while there may be an improvement at follow-up, at the end of treatment the evidence quality was very low and effects were uncertain.Other outcome domains examined for people with dementia included mood, functioning in daily activities, agitation/irritability and relationship quality. There were no clear effects in these domains. Individual reminiscence was probably associated with a slight benefit on depression scales, although its clinical importance was uncertain (SMD -0.41, 95% CI -0.76 to -0.06; 4 studies; 131 participants). We found no evidence of any harmful effects on people with dementia.We also looked at outcomes for carers, including stress, mood and quality of relationship with the person with dementia (from the carer's perspective). We found no evidence of effects on carers other than a potential adverse outcome related to carer anxiety at longer-term follow-up, based on two studies that had involved the carer jointly in reminiscence groups with people with dementia. The control group carers were probably slightly less anxious (MD 0.56 points, 95% CI -0.17 to 1.30; 464 participants), but this result is of uncertain clinical importance, and is also consistent with little or no effect.

AUTHORS' CONCLUSIONS

The effects of reminiscence interventions are inconsistent, often small in size and can differ considerably across settings and modalities. RT has some positive effects on people with dementia in the domains of QoL, cognition, communication and mood. Care home studies show the widest range of benefits, including QoL, cognition and communication (at follow-up). Individual RT is associated with probable benefits for cognition and mood. Group RT and a community setting are associated with probable improvements in communication. The wide range of RT interventions across studies makes comparisons and evaluation of relative benefits difficult. Treatment protocols are not described in sufficient detail in many publications. There have been welcome improvements in the quality of research on RT since the previous version of this review, although there still remains a need for more randomised controlled trials following clear, detailed treatment protocols, especially allowing the effects of simple and integrative RT to be compared.

It makes you keep trying: Life review writing for older adults

Life review writing produces numerous psychosocial benefits for older adults, who are at risk for isolation and depression. This article shares findings from a study that examined the experiences of older adults participating in a life review writing group. The impact of gender composition on the group dynamic was also explored. Using interpretative phenomenological analysis, this study explored the experiences of six women and one man who participated in a life review writing group. Six unifying themes emerged from the research findings: (1) legacy, (2) connecting with others, (3) reflection, (4) vitality, (5) structure of the group, and (6) gender dynamics. Implications for theory, practice, and research are discussed.

A Novel and Intelligent Home Monitoring System for Care Support of Elders with Cognitive Impairment

BACKGROUND

Assistive technology, in the form of a smart home environment, is employed to support people with dementia.

OBJECTIVES

To propose a system for continuous and objective remote monitoring of problematic daily living activity areas and design personalized interventions based on system feedback and clinical observations for improving cognitive function and health-related quality of life.

METHODS

The assistive technology of the proposed system, including wearable, sleep, object motion, presence, and utility usage sensors, was methodically deployed at four different home installations of people with cognitive impairment. Detection of sleep patterns, physical activity, and activities of daily living, based on the collected sensor data and analytics, was available at all times through comprehensive data visualization solutions. Combined with clinical observation, targeted psychosocial interventions were introduced to enhance the participants' quality of life and improve their cognitive functions and daily functionality. Meanwhile, participants and their caregivers were able to visualize a reduced set of information tailored to their needs.

RESULTS

Overall, paired-sample t-test analysis of monitored qualities revealed improvement for all participants in neuropsychological assessment. Moreover, improvement was detected from the beginning to the end of the trial, in physical condition and in the domains of sleep. Detecting abnormalities via the system, for example in sleep quality, such as REM sleep, has proved to be critical to assess current status, drive interventions, and evaluate improvements in a reliable manner.

CONCLUSION

It has been proved that the proposed system is suitable to support clinicians to reliably drive and evaluate clinical interventions toward quality of life improvement of people with cognitive impairment.

Effect of a social intervention of choice vs. control on depressive symptoms, melancholy, feeling of loneliness, and perceived togetherness in older Finnish people: a randomized controlled trial

OBJECTIVES

This study examined effects of a social intervention on depressive symptoms, melancholy, loneliness, and perceived togetherness in community-dwelling Finnish older people.

METHOD

Promotion of mental well-being in older people (GoodMood; ISRCTN78426775) was a single-blinded randomized control trial lasting 1.5 years. Two hundred and twenty-three persons aged 75-79 years reporting symptoms of loneliness or melancholy were randomized into intervention and control groups. The intervention group was allowed to choose among supervised exercise, social activity, or personal counseling. Follow-up measurements were conducted at the end of 6-month intervention, and at 3, 6, and 12 months post intervention.

RESULTS

Number of depressive symptoms remained unchanged, while loneliness and melancholy decreased in both the intervention and control groups during the study (p < 0.001). Social integration increased in the intervention group but not in controls (p = 0.041). Attachment and guidance increased in both groups (p < 0.001).

CONCLUSION

The intervention did not alleviate depressed mood. Positive changes over time were observed in loneliness, feelings of melancholy, attachment, and guidance but these occurred independently of the intervention. Our secondary analysis suggests that the intervention increased perceived social integration. In sum, the effects of the intervention were moderate only and did not expedite further overcoming depressive mood or loneliness.

The clinical efficacy of reminiscence therapy in patients with mild-to-moderate Alzheimer disease: Study protocol for a randomized parallel-design controlled trial

INTRODUCTION

Alzheimer disease (AD) is one of the most common diseases among the older adults. Currently, various nonpharmacological interventions are used for the treatment of AD. Such as reminiscence therapy is being widely used in Western countries. However, it is often used as an empirical application in China; the evidence-based efficacy of reminiscence therapy in AD patients remains to be determined. Therefore, the aim of this research is to assess the effectives of reminiscence therapy for Chinese elderly.

METHODS AND ANALYSIS

This is a randomized parallel-design controlled trial. Mild and moderate AD patients who are in the Beijing Geriatric Hospital, China will be randomized into control and intervention groups (n = 45 for each group). For the intervention group, along with conventional drug therapy, participants will be exposed to a reminiscence therapy of 35 to 45 minutes, 2 times/wk for 12 consecutive weeks. Patients in the control group will undergo conventional drug therapy only. The primary outcome measure will be the differences in Alzheimer disease Assessment Scale-Cognitive Section Score. The secondary outcome measures will be the differences in the Cornell scale for depression in dementia, Neuropsychiatric Inventory score, and Barthel Index scores at baseline, at 4 and 12 weeks of treatment, and 12 weeks after treatment.

ETHICS AND DISSEMINATION

The protocols have been approved by the ethics committee of Beijing Geriatric Hospital of China (approval no. 2015-010). Findings will be disseminated through presentation at scientific conferences and in academic journals.

TRIAL REGISTRATION

Chinese Clinical Trial Registry identifier ChiCTR-INR-16009505.

It was all planned … now what? Claiming agency in later life in reforming China

This study explores the social construction of agency and wellbeing among 20 Chinese urban retirees aged between 50 and 82 years old (averaging 67), with a special focus on the impact of earlier life experiences in shaping later-life pathways. Today's retirees in urban China have experienced the communist collectivist ideology during the Mao era as well as the changes to everyday life brought about by the economic transformation from centrally planned socialism to a market-orientated economy. Thereby, life in retirement for Chinese elders becomes more than just an issue of dealing with increases in discretionary time after exit from full-time work, but also one of making sense of their earlier life experiences in the midst of dramatic social changes. A grounded theory approach with semi-structured, in-depth, face-to-face interviews was used for data collection and analysis. Three interrelated themes emerged: (a) reminiscence as a mechanism of meaning-making, (b) discovery and exercise of agency in later life in contrast to a rigidly structured earlier life, and (c) varying pathways to constructing the life-stage of retirement. The findings have refuted gerontological literature and public discourse that often portray Chinese elders as passive care recipients or helpless dependants. Further, the present study has practical implications for developing policies, designing programmes and providing services to improve the quality of life for today's older Chinese people.

Benefits of Well-Being Training in Healthy Older Adults

INTRODUCTION

Several studies have shown that psychological well-being (PWB) can be promoted through positive psychological interventions (PPIs). Although these interventions have shown promising results in clinical settings, only a few studies have investigated their effectiveness in older adults, and they have rarely considered an active control group. In addition, generalisation effects of the PWB training to quality of life (QoL) and to untrained cognitive abilities have never been considered.

OBJECTIVE

In this study, we evaluated the effectiveness of a six-session PWB intervention aiming specifically to improve PWB, and sought any transfer effects on an aspect related to PWB, QoL. Transfer effects on a high-level cognitive process, working memory (WM), were also investigated.

METHODS

Thirty-two older adults (61-82 years old) volunteered to take part in the study and were randomly assigned to either a training group or an active control group.

RESULTS

Only the trained group, once controlled for variability, reported larger gains in PWB and in WM performance after the training.

CONCLUSIONS

This pilot study suggests that PWB training can be effective in older adults, with a positive generalisation effect on cognition (WM). The discussion focuses on the need to develop PPIs tailored to older adults' needs and resources.

A hermeneutic phenomenological explorations of living in old age

Although there have been some studies that explore the meaning of aging and give voice to older people, the impact that the aging experience can have on them justifies continued research in this area. In this study, with a hermeneutic phenomenological design and an interpretation method inspired by the philosophy of Ricoeur, we conducted in-depth interviews with 14 elderly people at a social day center in Rome (Italy). The analysis revealed three central themes associated with the experience of being old: changes and limitations related with being aged, the experience that comes from having lived a long life, and an awareness of death. The findings could help health professionals, families and caregivers to achieve a deeper understanding of what old age entails, and may also serve as a platform for interventions that seek to enable older people to experience aging as a meaningful and positive process.

Functions and Value of Reminiscence for Nursing Home Staff

The purpose of the current study was to understand (a) the extent to which reminiscence is used among nursing home staff (RNs, licensed practical nurses, and certified nursing assistants), (b) the reasons nursing home staff engage in reminiscence activities with nursing home residents, and (c) the value they attribute to these activities. The degree to which engagement in reminiscence activities by nursing staff contributed to knowledge about residents was also explored. The most frequently used functions of reminiscence, as reported by nursing staff, were to calm anxiety, help residents see meaning in life, and reorient confused residents. Although nursing caregivers (N = 43) found reminiscence activities moderately to very enjoyable (76.5%), less than one half (46.5%) reported engaging in reminiscence activities with residents frequently or very frequently. Nurses who engaged in reminiscence activities more often also reported knowing residents better-a hallmark of high-quality care for residents with dementia. [Journal of Gerontological Nursing, 43(6), 35-43.].

Factors that bring meaning to mementos created by elders

OBJECTIVES

Reminiscing activity groups are commonly seen in various elder care settings This study addresses the impact of reminiscence activity groups, specifically a program where group members create their own mementos, on healthy Jewish elders' sense of satisfaction and meaning. In particular, this research focused on the specific factors involved in creating the mementos themselves.

METHOD

In this mixed methods study, occupational therapy graduate students synthesized relevant aspects of commonly used activity analysis forms into a matrix to analyze the activities. From a pool of 30 activities, students chose seven representing many factors and levels of complexity. With a matrix composed of a Likert scale and open-ended questions, students and Jewish elders explored the elders' perceptions of factors significantly related to their experiences when creating the seven mementos.

RESULTS

Memento-making was most satisfying when elders were replicated in some way, such as with hand casting. Least satisfying activities were those that could lead to talents being appraised, such as painted self-portraits. Unanticipated factors such as social participation and educating others appeared to be as important as making the mementos themselves.

CONCLUSION

While the research questions were partially answered, factors such as meaning and creativity were difficult constructs to measure because they lacked clear definitions. However, this preliminary exploration supports the concept that the use of an activity analysis matrix can enable activities directors and occupational therapists to systematically ascertain which factors positively impact well-being and social participation to meet the unique needs of aging client populations.

Effect of anxiety on memory for emotional information in older adults

BACKGROUND

Several studies have shown that anxiety is associated with a better memory of negative events. However, this anxiety-related memory bias has not been studied in the elderly, in which there is a preferential processing of positive information.

OBJECTIVES

To study the effect of anxiety in a recognition task and an autobiographical memory task in 102 older adults with high and low levels of trait anxiety.

METHOD

Negative, positive and neutral pictures were used in the recognition task. In the autobiographical memory task, memories of the participants' lives were recorded, how they felt when thinking about them, and the personal relevance of these memories.

RESULTS

In the recognition task, no anxiety-related bias was found toward negative information. Individuals with high trait anxiety were found to remember less positive pictures than those with low trait anxiety. In the autobiographical memory task, both groups remembered negative and positive events equally. However, people with high trait anxiety remembered life experiences with more negative emotions, especially when remembering negative events. Individuals with low trait anxiety tended to feel more positive emotions when remembering their life experiences and most of these referred to feeling positive emotions when remembering negative events.

CONCLUSIONS

Older adults with anxiety tend to recognize less positive information and to present more negative emotions when remembering life events; while individuals without anxiety have a more positive experience of negative memories.

Effects of life review interventions on psychosocial outcomes among older adults: A systematic review and meta-analysis

AIM

The present study aimed to evaluate the effects of life review interventions on psychosocial outcomes among older adults.

METHODS

We searched PubMed, Ovid, CINHAL, Cochrane library, PsycINFO, Springer Link, Oxford Journals Collection, FRMS, CBM, VIP, CNKI, and Wanfang to identify randomized controlled trials and controlled clinical trials that evaluate the effects of life review among older adults. The quality of studies included was evaluated and the relevant information was extracted. Then, a meta-analysis was carried out with RevMan software.

RESULTS

We identified 15 studies that met the inclusion criteria, and 11 studies were allowed for meta-analysis. The combined results of the meta-analysis showed that life review significantly reduced depression (standardized mean difference 0.57, 95% CI 0.73 to -0.42) and hopelessness (mean difference [MD] 4.01, 95% CI 6.13 to -1.89). There was a significant improvement in well-being (standardized mean difference 0.54, 95% CI 0.01-1.06) and specific memory (MD 1.05, 95% CI 0.07-2.03). However, other study findings did not support its effect in life satisfaction (MD 2.15, 95% CI 0.69- 5.00), self-esteem (MD 0.21, 95% CI 2.09-2.50), the quality of life (standardized mean difference 0.15, 95% CI 0.96-0.66), extended memory (MD 0.03, 95% CI 0.61-0.55), categorical memory (MD 0.48, 95% CI 1.08- 0.12) and no recall (MD 0.30, 95% CI 1.12- 0.52).

CONCLUSIONS

Life review is a worthwhile intervention for reducing depression and hopelessness, and improving quality of life, well-being and specific memory in older adults. More well-designed trials with a large sample and long-term follow up are necessary to confirm the effects of life review on other psychosocial outcomes. Geriatr Gerontol Int 2017; 17: 1344-1357.

The suffering in silence of older parents whose child died of cancer: A qualitative study

As life expectancy grows, the death of an adult child becomes a highly prevalent problem for older adults. The present study is based on nine interviews and explores the experience of parents (≥70 years) outliving an adult child. The bereaved parents described some silencing processes constraining their expression of grief. When an adult dies, the social support system nearly automatically directs its care towards the bereaved nuclear family. Parental grief at old age is therefore often not recognized and/or acknowledged. Health care providers should be sensitive to the silent grief of older parents both in geriatric and oncology care settings.

'Singing for the Brain': A qualitative study exploring the health and well-being benefits of singing for people with dementia and their carers

Dementia has detrimental effects on cognitive, psychological and behavioural functioning, as well as significant impact on those who provide care. There is a need to find suitable psychosocial interventions to help manage the condition, enhance well-being, and to provide support for caregivers. This study explored the impact of Singing for the Brain™, an intervention based on group singing activities developed by The Alzheimer's Society for people with dementia and their carers. This qualitative study used semi-structured interviews with people with dementia and their carers. Ten interviews involving 20 participants were analysed thematically. Social inclusiveness and improvements in relationships, memory and mood were found to be especially important to participants. As well as enjoying the sessions, participants found that attending Singing for the Brain™ helped in accepting and coping with dementia.

Physical, social, psychological and existential trajectories of loss and adaptation towards the end of life for older people living with frailty: a serial interview study

Background

The experiences of people with cancer and organ disease have been described across different dimensions of need as they approach death. Such information is lacking for frail older people approaching death, but could highlight how a palliative approach might be relevant for this population.

Methods

Cognitively intact, community dwelling adults considered to be moderately or severely frail were recruited from a medical day hospital. Those recruited nominated an informal carer and case-linked professional. Qualitative in-depth serial interviews with older people and their informal carers were conducted over an 18 month period, and single interviews with case-linked healthcare professionals. Interviews were recorded, transcribed and narrative analytical techniques were used to compile case studies.

Results

Thirty-four participants (13 patients, 13 informal carers and 8 healthcare professionals) completed 40 individual, 14 joint and 8 professional interviews. Five patients died during the study. The analysis highlighted a dynamic balance between losses and adaptations. Three typical patterns of multi-dimensional change emerged. 1) Maintenance of psychological and existential well-being with a gradual social decline mirroring the physical deterioration. 2) a gradual reduction in both psychological and existential well-being. 3) a marked downturn in social, psychological and existential well-being before death. Frail older people sustained their well-being through maintaining a sense-of-self, garnering support from carers and community structures, and focusing on living from day to day. Their well-being lessened when they lost their sense-of-self, feeling alienated from the world, and confused over the cause of their circumstances. Death remained distant and ‘undiagnosed’. Social and community frameworks were essential for supporting their well-being.

Conclusions

Multidimensional end-of-life trajectories for frail older people differed from those with other conditions. Alleviating psychological, social and existential distress should be a priority of care as frail older people reach the end of life. The current palliative care model is problematic for this group. Care should address future concerns and not necessarily involve a focus on death or place of death.

Integrated working and intergenerational projects

Purpose

The purpose of this paper is to promote discussion about, and the development of the evidence-base underpinning integrated working for intergenerational working. It discusses perspectives on intergenerational work in general and specifically draws on case experiences of the use of intergenerational reminiscence based on sporting memories to highlight issues pertaining to integrated working.

Design/methodology/approach

The paper presents a general discussion of issues of intergenerational projects and integrated working, with case discussions of the use of sporting memories as an intervention for focusing intergenerational contact.

Findings

It is concluded that intergenerational work has much to offer but that it is far from clear how best to organise integrated working for this type of work. There are interesting lessons to be drawn for intergenerational interventions and integrated working from the case study discussions.

Research limitations/implications

Although case studies can provide crucial in-depth knowledge they can be limited in developing evidence we can be sure is more generalisable across contexts. Hence, further research is required into the impact of intergenerational projects, and how best to maximise this through effective integrated working.

Practical implications

The discussion and case study materials suggest there is much potential in using intergenerational projects to achieve a range of possible outcomes but it is not clear how integrated working is best operationalised in such work. Care is required about clarity concerning the aims of specific projects, but practitioners and others should be encouraged to carefully explore this area of work.

Social implications

The challenges of an ageing society are significant, as is the need to maintain intergenerational contact, mutuality and the implicit social contract across generations. Specifically developing opportunities for such contact may help achieve this and a range of other positive outcomes.

Originality/value

This paper brings together a discussion of intergenerational projects with consideration of the challenges of integrated working, and adds specific case study lessons from the use of sports-based reminiscence.

Beliefs about savoring in older adulthood: Aging and perceived health affect temporal components of perceived savoring ability

The ability to savor positive life events is associated with higher emotional well-being; however, few studies have examined savoring ability in older adults. The present study used a longitudinal design to examine changes in perceived savoring abilities and associations with perceived health in older adulthood. Older adults (N=131) reported on beliefs about savoring and perceived health at baseline and 2½ years later. Perceived anticipation (savoring the future) and reminiscing (savoring the past) abilities declined from baseline to follow-up. Better perceived health at baseline predicted greater perceived reminiscing and anticipation abilities at follow-up. Greater perceived ability to savor the present moment at baseline predicted better perceived health at follow-up. Aging and poorer health focus older adults' thoughts on present-moment pleasures, which may benefit health, but may also lead to reductions in perceived anticipation and reminiscing abilities.

Can We Increase Psychological Well-Being? The Effects of Interventions on Psychological Well-Being: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

There is a rapidly growing interest in psychological well-being (PWB) as outcome of interventions. Ryff developed theory-based indicators of PWB that are consistent with a eudaimonic perspective of happiness. Numerous interventions have been developed with the aim to increase PWB. However, the effects on PWB measured as coherent outcome have not been examined across studies yet. This meta-analysis of randomized controlled trials of behavioral interventions aims to answer the question whether it is possible to enhance PWB.

METHODS

A systematic literature search was performed in PsycINFO, Cochrane and Web of Science. To be included, studies had to be randomized controlled trials of behavioral interventions with psychological well-being as primary or secondary outcome measure, measured with either Ryff's Psychological Well-Being Scales or the Mental Health Continuum-Short Form. The meta-analysis was performed using a random effects model. From the 2,298 articles found, 27 met the inclusion criteria. The included studies involved 3,579 participants.

RESULTS

We found a moderate effect (Cohen's d = 0.44; z = 5.62; p < .001). Heterogeneity between the studies was large (Q (26) = 134.12; p < .001; I2 = 80.62). At follow-up after two to ten months, a small but still significant effect size of 0.22 was found. There was no clear indication of publication bias. Interventions were more effective in clinical groups and when they were delivered individually. Effects were larger in studies of lower quality.

CONCLUSIONS

It appears to be possible to improve PWB with behavioral interventions. The results are promising for the further development and implementation of interventions to promote PWB. Delivering interventions face-to-face seems to be the most promising option. We recommend to keep including clinical groups in the research of psychological well-being. Heterogeneity is a limitation of the study and there is need for more high-quality studies.

A quasi-experimental study of a reminiscence program focused on autobiographical memory in institutionalized older adults with cognitive impairment

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.

Apolipoprotein E (APOE) ε4 and episodic memory decline in Alzheimer's disease: A review

A growing body of research has examined the relationship between episodic memory decline, the cognitive hallmark of Alzheimer's disease (AD), and the presence of Apolipoprotein E ε4 (APOE ε4) allele, a major genetic risk factor for the disease. Our review attempts to summarize and critically evaluate this literature. We performed a systematic search for studies assessing episodic memory in AD patients who were genotyped for APOE ε4 and identified fourteen papers. Although most of these papers reported significant relationships between APOE ε4 and episodic memory decline in AD, some papers did not confirm this relationship. Our review links this controversy to the conflicting literature about the effects of APOE ε4 on general cognitive functioning in AD. We identify several shortcoming and limitations of the research on the relationship between APOE ε4 and episodic memory in AD, such as small sample sizes, non-representative populations, lack of comparison of early-onset vs. late-onset disease, and lack of comparison among different genotypes that include APOE ε4 (i.e., zero, one, or two ε4 alleles). Another major shortcoming of the reviewed literature was the lack of comprehensive evaluation of episodic memory decline, since episodic memory was solely evaluated with regard to encoding and retrieval, omitting evaluation of core episodic features that decline in AD, such as context recall (e.g., how, where, and when an episodic event has occurred) and subjective experience of remembering (e.g., reliving, emotion and feeling during episodic recollection). Future research taking these limitations into consideration could illuminate the nature of the relationship between APOE ε4 and episodic memory decline in AD.

Development of two measures of client engagement for use in home aged care

The aim of the study was to develop and validate measures of client engagement in aged homecare. The Homecare Measure of Engagement-Staff questionnaire (HoME-S) is a self-complete measure of six dimensions of client engagement: client acceptance, attention, attitude, appropriateness, engagement duration and passivity. The Homecare Measure of Engagement-Client/Family report (HoME-CF) is a researcher-rated interview which obtains client and/or family perspectives regarding frequency and valence of conversational and recreational engagement during care worker visits. Care workers (n = 84) completed the HoME-S and a measure of relationship bond with client. Researchers interviewed clients (n = 164) and/or their family (n = 117) and completed the HoME-CF, and measures of agitation, dysphoria, apathy and cognitive functioning. The HoME-S and HoME-CF demonstrated good test-retest and inter-rater reliability, and showed significant negative correlations with apathy, agitation and non-English-speaking background. Controlling for client and care service characteristics, a stronger care worker-client relationship bond and English-speaking background were independently associated with higher HoME-S scores, and apathy was independently associated with higher HoME-CF scores. In conclusion, the HoME-S and HoME-CF are psychometrically sound engagement measures for use in homecare. Clients who are apathetic or from non-English-speaking backgrounds may be less responsive to traditional care worker engagement strategies. Engagement may be augmented in clients who have stronger relationships with their care workers.

Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion

In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.