Can Family Caregivers Provide Life Review to Reduce Depression in Older Adults With Dementia?

Life review for older adults: an integrative review

Life review therapy is a form of psychotherapy framework which involves the guided reflection of life events throughout a patient's life journey. Patients are encouraged to actively recall and analyze important life events, both negative and positive. Through this process, patients may be able to come to terms with, or even resolve negative events such as conflicts and regrets. The aim of this study is to gain an understanding of the current knowledge of the use of life review therapy in older adults, and to identify areas for future research. A systematic literature search was conducted across CINAHL, Medline, PsycInfo, Embase and Scopus. Papers were screened and selected using predetermined inclusion and exclusion criteria using Covidence and exported into Excel. Data analysis was conducted to synthesise thematic analyses. One hundred and thirty-one articles from 1974 to 2023 were included in this study and were used to develop four themes: life satisfaction and self-esteem, depression and depressive symptoms, institutional care and cognitive decline, and post-traumatic stress disorder (PTSD) and trauma. Life review has some benefit in older adults in certain groups and situations, although the extent and duration of effectiveness of this benefit is unclear. Life review unlikely improves self-esteem. However, in the short term, life review appears to improve life satisfaction, depression or depressive symptoms, and PTSD symptoms in the elderly. Life review may be a useful therapeutic tool for older adults with cognitive decline for as long as the intervention continues. Areas for future research are explored.

Feasibility and Efficacy of Life Review Delivered by Virtually-Trained Family Caregivers

BACKGROUND

Due to the high prevalence of depressive symptoms and Alzheimer's disease and related dementias in older Americans (≥65 years), we developed a six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients (CRs) with early-stage dementia and mild depression.

OBJECTIVE

The objective of the study was to examine the feasibility and efficacy of C-PLR delivered by virtually-trained caregivers (CGs) on CRs who live with dementia and depression in community and long-term care settings (N = 25 CG-CR dyads).

METHODS

We used fidelity scores as a measure of CG's feasibility to provide C-PLR. We collected the pre- and post-measures on CRs' depression (primary outcome), life satisfaction, CGs' burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated if the effect differed by race/ethnicity, residential setting, or living alone.

RESULTS

The average fidelity check-in score was 14.8±0.78 indicating high feasibility. CGs were 52 years old (mean), 88% female, 64% working, 72% college-educated, and 72% in good-excellent health. CRs were 81 years old (mean), 84% female, and 56% in poor-fair health. CRs' depression significantly improved (p < 0.001), and this effect was found in CRs who were Asian (p = 0.017), White (p = 0.040), community-dwelling (p < 0.001), lived alone (p = 0.045), or with others (p = 0.002).

CONCLUSION

This study demonstrated that the C-PLR can be successfully taught to CGs virtually and is effective in reducing CR's depressive symptoms. C-PLR could be implemented more broadly to improve symptoms among CRs in community and residential settings, as well as among a diverse population of CRs.

Feasibility Study of Caregiver-Provided Life Review: Implementation, Adaptation, and Effects on Care Recipients' Depressive Symptoms

OBJECTIVES

This study aimed to examine the feasibility of unpaid, family/friend caregivers conducting life reviews with people with dementia in long-term care and community settings and reported on how we adapted the intervention modality under the COVID-19 pandemic.

METHODS

Twenty-one caregiver-care recipient dyads completed 6 weekly life review sessions. The intervention format was modified to accommodate COVID-19 restrictions. Primary and secondary outcome measures were analyzed based on repeated measures at baseline and post-intervention.

RESULTS

Due to the changing nature of the pandemic, we iterated the caregiver training intervention four times to accommodate caregivers' needs while having faced multiple recruitment challenges with care facility residents. Care recipients' depression appeared to have improved (p = .001).

CONCLUSIONS

Although the COVID-19 pandemic created unique recruitment challenges, all the care recipients seemed to enjoy the life review activities supported by the positive outcomes in gaining socialization opportunities. It may be beneficial to offer a more self-paced intervention modality to ease the burden on caregivers.

CLINICAL IMPLICATIONS

It appears that unpaid family/friend caregivers can provide life reviews to their loved ones with dementia. Training the caregivers on how to provide life reviews can be an easy, low-risk activity that might ameliorate depressive symptoms in the care recipients.