Trauma & Acute Care Open Access

Keywords

Depression; Reminiscence therapy; Literature review

Introduction

People around the world are ageing rapidly, and there are more than 900 million people over age 60 years around the world. Between 2015 and 2050 the number will be double from about 12% to 22% and the number will be 2 billion people [1]. In Jordan, according to the Central Inelegance Agency [2], people who are 65 years and over poses 5.1% from the general population, nearly 145,515 are male and 162,055 female.

Older people face several physical and mental health challenges which need to be recognized, over 20% of adults aged 60 and over suffer from a mental or neurological disorder and 6.6% of all disability and the most common neuropsychiatric disorders in are dementia and depression [1].

Depression is a widespread mood disorder and one of the leading causes of disability worldwide which cause a persistent feeling of sadness and loss of interest [3]. In elderly, depression occurs in 7% of the general elderly population, and they have poorer functioning more than elderly people with chronic medical conditions, as well as depression will increases the perception of poor health, the imposition of medical services and health care costs [1].

Additionally, symptoms of depression in older adults are often looked out and untreated because they concur with other problems, it can effects the mental health, the quality of life of the elderly and their physical health; it can cause severe emotional pain, decline in physical function, and the risk of death [4].

Fortunately, effective treatments for depression among elderly do exist; Reminiscence Therapy (RT) is one of the best psychological treatments for treating elderly with depression [5]. The Nursing Interventions Classification (NIC) defined the reminiscence therapy as ‘‘using the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, or adaptation to present circumstances’’ [6].

Also Reminiscence therapy considered as one method of using the memory to protect mental health and improve the quality of life by recalling the past events or experiences, reflecting on one’s life with a focus on re-evaluation in systematically way, resolving conflicts from the past, helping to find meaning in one’s life and assessing former adaptive coping responses and this therapy often done within group [7]. Integrative reminiscence therapy in one type of reminiscence therapy, it can be defined as a process that help the individuals to accept the negative past events, as well as resolve past conflicts, also it can help to find meaning and worth in life [8].

Several studies proposed that the reminiscence therapy effective in preventing and alleviating depressive symptoms among elderly, increasing their self-esteem, helping the elderly to cope with crises, loss, and life events and increasing their satisfaction and quality of life [4].

The evidence based practice is integration to the best evidence from studies and patient care data using a problem-solving approach [9]. Therefore, it is important to increase our understanding of the main causes, type of treatment, and management of depressive symptoms among elderly. The attitudes held by both nursing staff working within mental health services about the management of depressive symptoms among elderly are important such as reminiscence therapy that may influence decisions about intervention and treatment. The purpose of this evidence based review is to identify the effectiveness of reminiscence therapy in treating depressive symptoms among elderly.

Population, Intervention, Comparison, Outcome, and Time (PICOT) Format

PICOT format consist of five elements (a) population or patients (b) intervention (c) comparison (d) outcome (e) time, and it can be defined as approach that helpful to summarizing research questions which explore the effect of therapy (Table 1) [10].

Table 1: PICOT question framework.

PICOT questions

1. Does reminiscence therapy prevent or decrease depressive symptoms among elderly?

2. What is the difference between patients who received reminiscence intervention and patients who did not receive reminiscence intervention?

Search strategies

Depending on the evidence based practice way to find literature reviews by used online database that searched include PubMed, Wiley, Science, PsycINFO, and PILOTS database from 2010 to March 2016 with the following combination of keywords: reminiscence therapy, elderly, depression, clinical trial. Found many articles and studies that related to base variables of search, was chosen some of these articles and studies and read it to write this paper.

The inclusion criteria were:

1. Elderly patients who had depressive symptom (diagnosed with major depressive disorder or not yet diagnosed) male or female.

2. Using group or integrative reminiscence therapy to decrease depressive symptoms.

3. Articles written in English language.

4. Randomized controlled trials.

The exclusion criteria were:

Studies focusing on young people or people of any age.

Studies concerned with depression caused by physical illness.

Studies published prior to 2010.

Literature Review

During reading what are the articles conclude and described the clinical effectiveness of reminiscence therapy intervention on the depressive symptoms of older people, most of it discussed the efficacy of reminiscence therapy improving cognition and general behavioural, and enhancing well-being.

The author found a few studies have investigated the effect of reminiscence on nursing staff, as well as the current author did not find studies proposed that the group or integrative reminiscence therapy is in effective in reducing depressive symptoms. The aim of this review is to identify reminiscence therapy developed by whom, and to describe the goal, efficacy and number of sessions of reminiscence therapy.

Related studies

Reminiscence therapy developed in 1963 by Butler as a psychological intervention for older adults, and several studies concluded that reminiscence therapy is particularly well-established and acceptable forms of depression treatment [8]. According to Watt et al. [11] manual, this therapy consisted of six weekly sessions and each one take 90 min. During the session, the memories recalled focused on a different theme. These themes are; major branching points in client life, family life, client career or major life work, client loves and hates, stress experiences, the meaning of client’s life and belief.

In general, there are many studies which first level of evidence concluded that reminiscence therapy is effective in reducing depressive symptoms and improving interpersonal functioning of elderly. For instance, Elias et al. [12] systematic review of the effectiveness of reminiscence therapy for older adults with loneliness anxiety and depression, which has eight studies examining the effectiveness of reminiscence therapy and depression from 2002 to 2014, and all studies in this review were quantitative studies. The number of participants involved in the reminiscence therapy groups ranged from 21 to 73. The result of systematic review indicated that group reminiscence therapy is an effective treatment for depression in older adults.

Moreover, one randomized control study conducted by Su et al. [13], showed that reminiscence therapy considered effective on depression among elderly when they assigned 102 randomized patients to experimental and control groups, the experimental group received three sessions a week for 24 weeks, for a total of 72 sessions of reminiscence therapy, and the control group received a one to one simple supportive interview once a week during the same period. Furthermore, reminiscence therapy decreases depressive symptoms.

Another study of the effects of a reminiscence program among elderly by Moral et al. [14] proposed that, reminiscence intervention had positive effects in elderly participants. The 34 participant assigned into two groups (control and interventional) the intervention lasted eight sessions and compared a treatment group and a control group, using a quasi-experimental.

Additionally, Zhou et al. [4] study emphasized that group reminiscence therapy was effective in reducing symptoms of depression among 125 elderly participants, the elderly group who were in the control group received health education, and the intervention group received health education and reminiscence therapy during 6 weeks and one session for each week. They used experimental control trial in this study.

In Karimi et al. [8] randomized control study about the effectiveness of integrative reminiscence therapy among 29 older adult with depressive symptoms, they assigned for tow group (control and experimental group) the control group received social discussion and the experimental or interventional group received integrative reminiscence therapy. This study conducted that integrative reminisce therapy significantly effective in reducing depressive symptoms among interventional group.

Finally, in 2013 Chang [7] conducted a study among 21 male veterans about the effectiveness of reminiscence therapy in decreasing depressive symptoms, and they assigned into tow group (control and interventional) the interventional group had 8 sessions; tow session in a week for weekly for 4 weeks. The researcher used quasi-experimental research design, and the result of this study the showed that the interventional group significantly improved their depressive symptoms and geriatric depression compared with the control group and this therapy can reduce their depressive symptoms following the intervention.

All studies that reported positive outcomes regarding to the effectiveness of reminiscence therapy in reducing depressive symptoms are summarized in Tables 2 and 3.

Table 2: Summary of related studies.

Table 3: Summary of related studies.

Summary

The writer discussed the aim of this evidence based review, and it was to identify the effectiveness of reminiscence therapy in treating depressive symptoms among elderly, in literature reviews the current author clarified reminiscence therapy number of session. And discussed several studies related to the effectiveness of reminiscence therapy in decreasing the depressive symptoms among elderly using group or integrative reminiscence therapy.

Recommendation and Implication

In this paper, the writer recommended the importance of understanding the elderly needs and the common mental illnesses among them. As well as understanding reminiscence therapy, the component and the efficacy of reminiscence therapy in treating depressive symptoms among elderly. Understanding the efficacy of this treatment can help the health team provider to determine which treatment is more appropriate. Also, reminiscence should be offered as a routine care to elderly patients who suffering from depressive symptom.

References

1. World Health Organization (2015) Mental health and older adults. Fact Sheet  N°381.
2. Central Inelegance Agency (2014) Jordan Demographics Profile 2014.
3. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. APA: Washington DC.
4. Zhou W, He G, Gao J, Yuan K, Feng H, et al. (2012) The effects of group reminiscence therapy on depression, self-esteem, and affect balance of Chinese community-dwelling elderly. Arch Gerontol Geriatr 54: 440–447.
5. Pinquart M, Forstmeier S (2012) Effects of reminiscence interventions on psychosocial outcomes: a meta-analysis. Aging Ment Health 16: 541-558.
6. Bulechek GM, Butcher HK, Dochterman JM (2008) Nursing Intervention Classification (NIC), 5th ed. Mosby, St. Louis.
7. Chen TJ, Li HJ, Li J (2012) The effects of reminiscence therapy on depressive symptoms of Chinese elderly: study protocol of a randomized controlled trial. BMC Psychiatry 12: 189.
8. Karimi H, Dolatshahee B, Momeni K, Khodabakhshi A, Rezaei M, et al. (2010) Effectiveness of integrative and instrumental reminiscence therapies on depression symptoms reduction in institutionalized older adults: An empirical study. Aging Ment Health 14: 881–887.
9. Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM (2010) Asking the clinical question: a key step in evidence-based practice Am J Nurs 110: 58-61.
10. Polit D, Beck C (2012) Essentials of nursing research : appraising evidence for nursing practice, 8th Ed Philadelphia: Lippincott Williams & Wilkins.
11. Watt LM, Cappeliez P (2000) Integrative and instrumental reminiscence therapies for depression in older adults: Intervention strategies and treatment effectiveness. Aging Ment Health 4:166–177.
12. Syed Elias SM, Neville C, Scott T (2015) The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: A systematic review. Geriatric Nursing 36: 372-380.
13. SuT, Wu L, Lin C (2012) The prevalence of dementia and depression in Taiwanese institutionalized leprosy patients, and the effectiveness evaluation of reminiscence therapy-a longitudinal, single blind, randomized control study. Int J Geriatr Psychiatry 27: 187–196.
14. Meléndez-Moral JC, Charco-Ruiz L, Mayordomo-Rodríguez T, Sales-Galán  A (2013) Effects of a reminiscence program among institutionalized elderly adults. Psicothema 25: 319-323.