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

Reminiscence interventions for loneliness reduction in older adults: a systematic review

OBJECTIVES

This study aims to review the use of reminiscence interventions in the reduction of loneliness in older adults by categorising the interventions by type, and comparing their effectiveness and methodological quality.

METHOD

This is a systematic review following PRISMA guidelines. The search was restricted to studies published in the Cochrane, CINAHL, Web of Science, Psycarticles, Psycinfo, and PubMed databases until December 2022. The inclusion criteria for the studies included in this review were: 1) reminiscence intervention 2) loneliness outcome measure 3) adults over 60 years old 4) experimental, pre-experimental, and quasi-experimental studies.

RESULTS

A total of twelve studies were eligible for inclusion. Only nine studies included a control group, and seven of those report significant effectiveness in reducing loneliness levels. The most popular type of intervention is simple reminiscence and life review, and in-group format. The interventions to date have been very heterogeneous, and the methodological quality of the existing literature is moderate to weak.

CONCLUSION

While reminiscence interventions hold some promise for reducing loneliness levels among older adults, future methodologically rigorous research is required, and standardised protocols need to be developed for application, with the specific aim of reducing levels of loneliness among older adults.

Looking back on life: An updated meta-analysis of the effect of life review therapy and reminiscence on late-life depression

BACKGROUND

Twenty years ago, we confirmed the effectiveness of life review therapy and reminiscence (LRT-REM) to treat late-life depression in a meta-analysis. In the current study, we aimed to examine the most updated evidence on the effects of LRT-REM in older adults with depression.

METHODS

We systematically searched records in English and Chinese databases up to December 2022 and included randomized controlled studies comparing LRT-REM with control conditions in older adults with depression. Outcomes included depression, anxiety, quality of life, and life satisfaction. Effect sizes (Hedges' g) at post-treatment were pooled with random effects meta-analyses.

RESULTS

42 studies with 3361 depressed older adults (≥60 years) met the selection criteria. We found a significant and large effect of LRT-REM (g = 1.41, p < 0.001) on late-life depression, corresponding to a number-needed-to-treat (NNT) of 1.98. Heterogeneity shrunk from high (I2 = 86.78) to moderate (I2 = 46.87) after excluding eight detected outliers. There were no significant differences between the examined subgroups except for the type of control condition. The effects of LRT-REM were not statistically significant at follow-up when corrected for publication bias. The quality of many included studies was not optimal.

LIMITATIONS

The quality of many included studies was not optimal, with a high risk of bias.

CONCLUSIONS

LRT-REM may be effective for treating late-life depression, but long-term effects are unclear. More research is needed on the effects of LRT-REM, especially when guided by (para)professional or lay therapists in low- and middle-income countries.

Revie ⊕: Impact of a resource-based life review intervention on patients with advanced cancer: A waitlist controlled trial

PURPOSE

Life review interventions aim to support individuals facing an incurable disease accompanied by existential concerns and health-related challenges. Based on encouraging feasibility results, this study assessed the effects of Revie ⊕ life review intervention on the self-esteem of patients with advanced cancer, and the effects on well-being, post-traumatic growth, life satisfaction, symptom burden and interaction with nurses.

METHOD

The study consisted of a two-arm parallel-group, waitlist-controlled trial (WCT) in the oncology division of a Swiss-French University Hospital. Revie ⊕ was composed of nurse-led meeting with the patient to address and document significant life events using a strengths-focused approach and targeting the life project.

RESULTS

Due to Covid-19 pandemic, adjustments were made regarding study duration and participant's allocation: Fifty-eight patients received Revie ⊕, 39 completed all the measurements. Self-esteem was high at baseline and maintained stability over time. The social well-being decreased in the intervention group before-after Revie ⊕ (-1.7 (3.9), p = 0.044) while emotional and functional well-being showed stability. The intensity of symptoms decreased in the intervention group before-after Revie ⊕: 4.9 (9.4), p = 0.020.

CONCLUSIONS

This study suggests that patients living with an advanced cancer and who received Revie ⊕ intervention may have maintained their self-esteem high over time. Observed results are promising, particularly considering the influence of the pandemic. Nevertheless, these findings do not allow us to draw definitive conclusions regarding the efficacy of the intervention on self-esteem. WCT seems not to be the appropriate design to highlight the added value of Revie ⊕ for this particularly vulnerable population.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04254926.

Effectiveness on Quality of Life and Life Satisfaction for Older Adults: A Systematic Review and Meta-Analysis of Life Review and Reminiscence Therapy across Settings

BACKGROUND

With the growing trend of ageing, there is an urgent need for effective interventions that enhance positive psychological functions among older adults.

OBJECTIVE

(1) To evaluate the effectiveness of life review and reminiscence therapy in enhancing the quality of life and life satisfaction among older adults. (2) To discover efficacious variables during interventions, such as form of intervention and number of sessions.

METHODS

Relevant randomized controlled trials in both English and Chinese languages were searched across eight databases. The meta-analysis was conducted by a random effects model using STATA 17. The registration number of this review is CRD42023424085.

RESULTS

Thirty-two studies with 2353 participants were included. Experimental groups of older adults significantly improved their quality of life (SMD 1.07; 95% CI 0.48 to 1.66; p < 0.001) and life satisfaction (SMD 1.12; 95% CI 0.63 to 1.60; p < 0.001). Subgroup analyses revealed that individual sessions of life review and reminiscence therapy had a more significant impact on improving quality of life and six to eight intervention sessions could enhance life satisfaction more effectively.

CONCLUSIONS

Life review and reminiscence therapy hold promise for application in medical and nursing care for older adults, suggesting the potential benefits of implementing intervention designs with effective settings for positive psychological functions.

Peer support meeting of people with dementia: a qualitative descriptive analysis of the discussions

BACKGROUND

Dementia cafés for people with dementia and their caregivers are promoted in national dementia policies. The effect of dementia cafés on people with dementia has been reported through narratives of caregivers who participated the dementia cafés. However, evidence derived from the data, which included only people with dementia, is sparse. The aim of this study is to analyze the narratives of people with dementia in peer support meetings in Tokyo where only people with dementia participate, i.e., caregivers were not present.

METHODS

People with dementia and older people with subjective cognitive impairment were recruited in our community-based participatory research centre. Based on the qualitative descriptive approach, we conducted a thematic analysis of the field notes, which was made through ethnographical observation of the meetings.

RESULTS

Twenty-five meetings were held from November 2018 to March 2020. The cumulative total number of participants was 196. First, the symptomatic problems related to living with dementia were mentioned, which were collectively named under the overarching category of 'Experience of living with dementia.' Second, questions and solutions to the various symptoms were discussed, which were named the 'Quest of Symptoms.' Third, we noted the narrative that reflected on daily life, feelings, and the life that one has led, which were named 'Life story.' Fourth, we noted narratives of how symptoms have improved and their world has expanded, which were named 'Hope.' Fifth and most importantly, narratives about compassion for people with dementia in the past and future, as well as for people of the same generation, were discussed, which were named 'Compassion.'

CONCLUSIONS

The lived experiences of people with dementia were revealed. Participants noted they were not just being cared for but exchanging information and exploring the symptoms; in other words, they were resilient. Furthermore, more positive aspects concerning living with dementia were discussed, such as 'Hope' and 'Compassion.' Further research concerning the discourse of people around the participants is necessary to evaluate the situation from multiple perspectives.

Effects of reminiscence therapy on psychological outcome among older adults without obvious cognitive impairment: A systematic review and meta-analysis

Introduction

Reminiscence therapy has been a high-benefit and low-cost measure of psychosocial intervention for older adults in recent years. It has attracted much attention in the intervention study of older adults without obvious cognitive impairment. This study aimed to evaluate the effects of reminiscence therapy on psychosocial outcomes among older adults without obvious cognitive impairment and analyze the divergences of different intervention programs (form, duration, and setting) on outcomes.

Methods

We searched the commonly used databases and used RevMan 5.4 in the meta-analysis (PROSPERO-ID: CRD42022315237). All eligible trials used the Cochrane Risk of Bias Tool and the Effective Public Health Practice Project quality assessment tool to identify the quality and determine the bias risk grade.

Results

Twenty-seven studies were included, involving 1,755 older adults. Meta-analysis showed that reminiscence therapy has a significant effect on both depression and life satisfaction. Group reminiscence played a significant role in improving life satisfaction. Depression symptoms were not affected by the intervention duration (P = 0.06), while life satisfaction was significantly improved after more than 8 weeks of intervention (P < 0.00001). Intervention settings drove differences in depressive symptoms (P = 0.02), and the effect size of the community was larger.

Conclusion

Reminiscence therapy can significantly reduce depressive symptoms and improve life satisfaction. There are different effects of reminiscence therapy in different intervention schemes on psychological outcomes among older adults. More well-designed trials with large sample sizes and long-term follow-ups are necessary to confirm and expand the present results.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=315237, identifier: CRD42022315237.

Life review on psychospiritual outcomes among older adults with life-threatening illnesses: A systematic review and meta-analysis

Background

At the intersection of old age and illness, older adults with life-threatening illnesses (LTI) are a group who often show resilience and seek validation of life, acceptance, and integration of past and now, even under the fear of loss, suffering, and dying evoked by life adversities. Life review has been widely conducted to help older adults enhance well-being and cope with burdens. Spirituality is an important part of an older adult' overall well-being, especially for those with LTI. However, few review studies examined the effectiveness of life review interventions on psychospiritual outcomes among this population. The aim of the study was to examine the effectiveness of life review on psychospiritual well-being among older adults with LTI.

Methods

A systematic review with meta-analysis following the recommendations of the Cochrane Collaboration was conducted. Database searches included PubMed, PsycINFO, the Cochrane Library, the Campbell Library, EBSCO, CNKI, and the Airiti Library up to March 2020. Gray literature and reference lists from relevant articles were also searched and reviewed.

Results

In total, 34 studies were included in the systematic review and the meta-analysis for outcomes of depression (n = 24), quality-of-life (QOL) (n = 10), anxiety (n = 5), life satisfaction (n = 3), mood (n = 3), apathy (n = 2), and general well-being (n = 2). Other psychospiritual outcome measures included spirituality, self-esteem, meaning in life, hope, and some multi-dimensional instruments. The studies greatly varied in program design, content, format, length, and more. Although with high heterogeneity, meta-analysis results demonstrated standardized mean differences in favor of life review in decreasing depression, anxiety, negative mood, and increasing positive mood and QOL compared with the control group.

Conclusion

This review calls for including more psycho-spiritual well-being measures among interventions for older adults with LTI, as well as studies with rigorous designs in future research.

My Life, My Story: Integrating a Life Story Narrative Component Into Medical Student Curricula

INTRODUCTION

Medical students experience burnout, depersonalization, and decreases in empathy throughout medical training. My Life, My Story (MLMS) is a narrative medicine project that aims to combat these adverse outcomes by teaching students to interview patients about their life story, with the goal of improving patient-centered care competencies, such as empathy.

METHODS

The MLMS project was started in the Veterans Affairs (VA) system and has since spread to dozens of VA sites. We adapted and integrated this project into the Warren Alpert Medical School of Brown University curriculum. As part of the required curriculum, first- and third-year medical students participated in a life story interview with a community-based volunteer or a patient in the inpatient hospital setting, transcribed the story, and reviewed the written story with the patient. We assessed student perceptions of the project, changes in empathy, and changes in burnout symptoms.

RESULTS

A total of 240 students participated in this project. Students spent an average of 70.7 minutes interviewing patients. A majority of the students believed MLMS was a good use of time (77%), fostered connection with patients (79%), and was effective in recognizing patients' thoughts and feelings (69%).

DISCUSSION

To our knowledge, this is one of the first life story interview interventions to be implemented into a required medical school curriculum and outside the VA setting. MLMS may assist students in improving clinical empathy skills and create a structure for medical trainees to better understand their patients.

Effectiveness of life review on depression among elderly: a systematic review and meta-analysis

Introduction

depression is considered one of the most common obstacles to daily life activities and quality of life in the elderly. Evidence is accumulating regarding the effectiveness of reminiscence and life review interventions in reducing depression and raising well-being in the elderly. The aim of this review was to determine the effects of life review interventions on depression outcomes among the elderly.

Methods

a search of the literature was performed through 11 electronic databases to identify all randomized controlled trials studies that examine life review effects on depression among the elderly. For each study, the effect size (Cohen's d) between groups (life review vs. control) differences in depression scores for post-intervention and follow-up intervention were computed.

Results

in total, 15 studies were met the inclusion criteria and was evaluated by meta-analysis. Results showed that the life review group has a large effect on reducing depression level than the control group on post-intervention and follow-up. After conducted sensitivity analysis, a moderate effect (effect size=-0.54; 95% CI=-0.71 to -0.36; p<0.05) and small effect (effect size=-0.20; 95% CI=-0.41 to -0.01; p<0.05) were found on post-intervention and follow-up, respectively.

Conclusion

through this systematic review and meta-analysis, the overall results showed a moderate effect to reducing depression levels among the elderly in the life review group after carrying out post-intervention measurements, while in the follow-up the effect was small. This review indicates that life review intervention is one of the options likely to be of benefit for elderly in primary care settings, but further research can be focused on intervention and follow-up durations to obtain long-term effects.

Psychosocial and quality of life impact of scars in the surgical, traumatic and burn populations: a scoping review protocol

INTRODUCTION

Despite the fact that millions of scars affect individuals annually, little is known about their psychosocial impact and overall quality of life (QOL) on individuals. Scars from multiple aetiologies may cause psychiatric and emotional disturbances, can limit physical functioning and increase costs to the healthcare system. The purpose of this protocol is to describe the methodological considerations that will guide the completion of a scoping review that will summarise the extent, range and nature of psychosocial health outcomes and QOL of scars of all aetiologies.

METHODS AND ANALYSIS

A modified Arksey and O'Malley (2005) framework will be completed, namely having ongoing consultation between experts from the beginning of the process, then (1) identifying the research question/s, (2) identifying the relevant studies from electronic databases and grey literature, with (3) study selection and (4) charting of data by two independent coders, and (5) collating, summarising and reporting data. Experts will include a health information specialist (TAW), scar expert (JSF), scoping review consultant (SCK), as well as at least two independent coders (NZ, AM).

ETHICS AND DISSEMINATION

Ethics approval will not be sought for this scoping review. We plan to disseminate this research through publications, presentations and meetings with relevant stakeholders.

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

OBJECTIVE

To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning.

DESIGN

Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017).

SETTING

Home/community.

PARTICIPANTS

People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety.

INTERVENTIONS

Non-pharmacological interventions targeted at depression/anxiety.

MEASUREMENTS

We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool.

RESULTS

We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n = 5 trials, mean difference in Hamilton Depression Rating Scale score -4.94 [95% CI -7.90 to -1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified.

CONCLUSION

PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population.

[Psychotherapeutic approaches for treatment of the elderly]

BACKGROUND

This article focusses on the possibilities, varieties, indications, and benefits of psychotherapy with elderly patients.

OBJECTIVE

Which basic principles can be differentiated, what theoretical rationales are helpful for psychotherapy with the elderly and what kind and forms of psychotherapy are available?

MATERIAL AND METHODS

Based on relevant references and research, clinically relevant and evidence-based psychotherapies are described, to understand the theoretical rationale, the goals, the procedure and main strategies.

RESULTS

Cognitive behavior therapy, problem solving therapy, life review therapy, interpersonal psychotherapy, and psychodynamic psychotherapy are available to treat various psychological and somatic problems in elderly patients. In particular, cognitive behavior therapy, problem solving therapy, and life review therapy are evidence-based and empirically validated. Evidence for interpersonal psychotherapy is mixed and for psychodynamic psychotherapy is missing.

CONCLUSION

Psychotherapy with old and very old patients is possible, well received, and successful. Age per se is no longer considered to be a relevant variable for indications of psychotherapy.