Life review with older women: an intervention to reduce depression and improve autobiographical memory

Effects of group reminiscence interventions on depressive symptoms and life satisfaction in older adults with intact cognition and mild cognitive impairment: A systematic review

OBJECTIVE

Reminiscence interventions have been extensively used to improve the psychological health of people with dementia. However, there is uncertainty about the effectiveness of group reminiscence interventions for older adults with intact cognition and mild cognitive impairment. Based on the large number of older adults and strained health care resources in China, we conducted a systematic review of the evidence on the effectiveness of group reminiscence interventions for older adults with intact cognition or mild cognitive impairment.

MATERIALS AND METHODS

Five English databases were searched from inception to 21 August 2022. The quality of the included articles was assessed by using the Cochrane Risk of Bias Scale or Criteria (2020) and the Australian Evidence-Based Health Care Centre (2020). Data related to study and intervention characteristics were extracted.

RESULTS

Twenty-four articles were included, of which eight were quasiexperimental studies and sixteen were randomized controlled studies. The overall study quality was high, but most studies did not blind the participants. Group reminiscence interventions were beneficial in improving depressive symptoms and life satisfaction in older adults with intact cognition or mild cognitive impairment, but no valid conclusions could be drawn about the effect on quality of life.

CONCLUSIONS

Group reminiscence interventions are an effective type of psychological intervention to improve the psychological health of older people. In addition, group reminiscence interventions are simple and easy to implement and can be considered a routine care activity to meet the spiritual needs of cognitively intact and mildly cognitively impaired older people.

Effects of saccadic eye movements on episodic & semantic memory fluency in older and younger participants

Research has demonstrated that performing a sequence of saccadic horizontal eye movements prior to retrieval facilitates performance on tests of episodic memory. This has been observed in both laboratory tasks of retention and autobiographical memory. To date, the work has centred on performance in younger individuals. This paper extends previous investigations by examining the effects of saccadic eye movements in older persons. Autobiographical episodic and semantic memory fluency was assessed in younger (age range 18-35, mean = 22.50), and older (age range 55-87, mean = 70.35) participants following saccadic (vs. fixation control) manipulations. The main effects of eye movements and age were found for episodic autobiographical memory (greater fluency after eye movements and in younger participants). Semantic autobiographical memory showed a main effect of age (greater fluency in younger participants), whereas general semantic memory showed no effect of age or eye movement. These findings indicate that saccadic horizontal eye movements can enhance episodic personal memory in older individuals. This has implications as a technique to improve autobiographical recollection in the elderly and as an adjunct in reminiscence therapy.

Effects of a Reminiscence Program on Meaning of Life, Sense of Coherence and Coping in Older Women Living in Nursing Homes during COVID-19

Aging is a dynamic process that can bring well-being but also physical and cognitive decline. Older adults can draw on their personal resources to help them cope and thrive through the aging process. Having personal resources to cope and ensure older adults’ well-being is important. Psychological strengths such as a sense of coherence, resilience, and coping are protective against the adversity associated with health problems such as those stemming from the COVID-19 pandemic. Our study’s purpose was to investigate the usefulness of reminiscence therapy for older women living in nursing homes during the COVID-19 pandemic. A sample composed of 29 older women was evaluated with the Purpose-in-Life Test (PIL), Sense of Coherence (SOC-13) and Brief Cope Inventory (COPE-28). Our reminiscence program consisted of 10 sessions lasting 60 min each. Reminiscence therapy is a psychological intervention for older adults to assist in remembering and interpreting the life events, feelings, and thoughts that define and give meaning to the person’s life. Reminiscence can lead to positive mental health and other elements of particular relevance to older adults. In each session, we worked on a different theme that promoted the memory of positive emotions: optimal experience, decisive moment, stresses, tensions, problems and solutions, memories of childhood, adolescence, maturity, significant people in life, sense of life, and future script. We compared an intervention group (n = 12) with a control group (n = 17) using a pre-post, single-blind design. Significant results were obtained and showed that reminiscence therapy was effective in increasing meaning of life, sense of coherence, and coping in older women. The reminiscence therapy applied yielded positive effects in older female participants living in a nursing home during COVID-19 pandemic.

A Systematic Review of Non-invasive Brain Stimulation Applications to Memory in Healthy Aging

It has long been acknowledged that memory changes over the course of one's life, irrespective of diseases like dementia. Approaches to mitigate these changes have however yielded mixed results. Brain stimulation has been identified as one novel approach of augmenting older adult's memory. Thus far, such approaches have however been nuanced, targeting different memory domains with different methodologies. This has produced an amalgam of research with an unclear image overall. This systematic review therefore aims to clarify this landscape, evaluating, and interpreting available research findings in a coherent manner. A systematic search of relevant literature was conducted across Medline, PsycInfo, Psycarticles and the Psychology and Behavioral Sciences Collection, which uncovered 44 studies employing non-invasive electrical brain stimulation in healthy older adults. All studies were of generally good quality spanning numerous memory domains. Within these, evidence was found for non-invasive brain stimulation augmenting working, episodic, associative, semantic, and procedural memory, with the first three domains having the greatest evidence base. Key sites for stimulation included the left dorsolateral prefrontal cortex (DLPFC), temporoparietal region, and primary motor cortex, with transcranial direct current stimulation (tDCS) holding the greatest literature base. Inconsistencies within the literature are highlighted and interpreted, however this discussion was constrained by potential confounding variables within the literature, a risk of bias, and challenges defining research aims and results. Non-invasive brain stimulation often did however have a positive and predictable impact on older adult's memory, and thus warrants further research to better understand these effects.

Applying Intervention Mapping to Improve the Applicability of Precious Memories, an Intervention for Depressive Symptoms in Nursing Home Residents

Precious memories (PM) is a life review intervention for depression in older adults with no to mild cognitive decline that has been implemented in multiple nursing homes (NHs) in the Netherlands. Previous research suggested its relevance but questioned its applicability. Therefore, this research aimed to (1) investigate the applicability of PM, and (2) increase its applicability, if necessary. Intervention mapping (IM) was used to achieve these goals: process evaluation through semi-structured interviews with psychologists (n = 11) and clients (n = 2) to identify potential improvements for PM and to set an improvement goal (IM-step 1); three focus groups with stakeholders (n = 20) to specify behaviors necessary to reach the improvement goal (IM-step 2); and selection of behavior change techniques and applications to facilitate attainment of these behaviors (IM-step 3). Results showed that psychologists perceived a high drop-out rate, which was partly due to PM being provided to clients that did not belong to the target group. Although PM was generally considered relevant, psychologists articulated its longer-term effects should be improved. To improve PM’s applicability, concrete maintenance strategies were developed aiming to maintain clients’ well-being by stimulating positive contact with others. Future research must pilot, implement and evaluate these strategies.

Precious memories: a randomized controlled trial on the effects of an autobiographical memory intervention delivered by trained volunteers in residential care homes

OBJECTIVES

This study assesses the effects of an autobiographical memory intervention on the prevention and reduction of depressive symptoms in older persons in residential care. Trained volunteers delivered the intervention.

METHODS

A randomized controlled trial was carried out with depressive symptoms as the primary outcome. The experimental condition received the intervention Precious Memories one-on-one, whereas the control condition had individual unstructured contacts with a volunteer. Participants were 86 older persons living in residential care. There were three measurements: pre-intervention, post-intervention (2 months after the first measurement), and follow-up (8 months after the first measurement). Besides depressive symptoms, the retrieval of specific positive memories was measured as a process variable. Anxiety, loneliness, well-being, and mastery were assessed as secondary outcomes.

RESULTS

Depressive symptoms improved equally in the intervention and the control condition at post-measurement. Participants with clinically relevant depressive symptoms also maintained the effects at follow-up in both conditions. The retrieval of specific positive memories improved more in the autobiographical memory intervention, although this was not maintained at follow-up. Anxiety and loneliness improved equally well in both conditions, but no effects were found for well-being or mastery.

CONCLUSION

It is concluded that volunteers can deliver the intervention and contribute to the mental health of this highly vulnerable group of older adults.

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.

Autobiographical memory, the ageing brain and mechanisms of psychological interventions

Elucidating the impact of healthy cognitive ageing and dementia on autobiographical memory (AM) may help deepen our theoretical understanding of memory and underlying neural changes. The distinction between episodic and semantic autobiographical memory is particularly informative in this regard. Psychological interventions, particularly those involving reminiscence or music, have led to differential effects on episodic and semantic autobiographical memory. We propose that executive function is a key mediator of psychological therapies on autobiographical memory. We also highlight that interventions that alleviate stress and improve mood, including in major depression, can enhance autobiographical memory. Future research employing more longitudinal approaches and examining moderating factors such as gender and education level will deepen our understanding of changes in AM in later life, enhance our theoretical understanding of the neuroscience of AM and ageing, and help to develop better targeted interventions for preserving AM in older adults.

It is not only memory: effects of sensecam on improving well-being in patients with mild alzheimer disease

BACKGROUND

Cognitive interventions (either restorative or compensatory) developed for mild Alzheimer's Disease (AD) have been tested widely with cognitive measures, but less is known about how the effects of such interventions are generalizable to daily functioning. In the present study, we looked at affective state and perceived functionality and quality of life indicators, for three different cognitive rehabilitation programs.

METHODS

Fifty-one AD patients in the mild stage of the disease were selected for the study and were randomly assigned to one of three cognitive training groups: (1) Memo+ (a paper and pencil memory training program); (2) SenseCam (wearable camera used as a passive external memory aid); (3) Written diary (a personal journal, used as control condition). All patients attended 11 sessions, twice a week, of 1-hour length. The three outcome indicators were examined with standardized instruments applied before the intervention, one week after and at six months follow-up.

RESULTS

After treatment, the SenseCam and Memo+ groups had significantly reduced depressive symptoms compared to the Diary control condition. The same was found for measures of perceived functional capacity. No intervention effects were found for quality of life measures. The immediate effects of the interventions were not maintained at follow-up.

CONCLUSIONS

Our results suggest that two types of memory rehabilitation can improve depressive symptomology and instrumental activities of daily living, suggesting that these interventions can stimulate not only cognition but also well-being, at least in the short term.

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.

Psychological Treatment of Depression in People Aged 65 Years and Over: A Systematic Review of Efficacy, Safety, and Cost-Effectiveness

Objectives

Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence.

Method

The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and PsycINFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Results

Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual.

Conclusion

Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.

Spiritual needs of elderly living in residential/nursing homes

While the research on spiritual needs of patients with chronic and life-threatening diseases increases, there is limited knowledge about psychosocial and spiritual needs of elderly living in residential/nursing homes. We were interested in which needs were of relevance at all, and how these needs are related to life satisfaction and mood states. For that purpose we enrolled 100 elderly living in residential/nursing homes (mean age 84 ± 7 years, 82% women) and provided standardized questionnaires, that is, Spiritual Needs Questionnaire (SpNQ), Brief Multidimensional Life Satisfaction Scale (BMLSS), Quality of Life in Elders with Multimorbidity (FLQM) questionnaire, and a mood states scale (ASTS). Religious needs and Existential needs were of low relevance, while inner peace needs were of some and needs for giving/generativity of highest relevance. Regression analyses revealed that the specific needs were predicted best by religious trust and mood states, particularly tiredness. However, life satisfaction and quality of life were not among the significant predictors. Most had the intention to connect with those who will remember them, although they fear that there is limited interest in their concerns. It remains an open issue how these unmet needs can be adequately supported.

Effects of reminiscence interventions on psychosocial outcomes: a meta-analysis

OBJECTIVES

This study integrated results from controlled trials of reminiscence interventions.

METHODS

Meta-analysis was used to aggregate results from 128 studies on 9 outcome VARIABLES.

RESULTS

Compared to non-specific changes in control-group members, moderate improvements were observed at posttest with regard to ego-integrity (g=0.64) and depression (g=0.57 standard deviation units). Small effects were found on purpose in life (g=0.48), death preparation (g=0.40), mastery (g=0.40), mental health symptoms (g=0.33), positive well-being (g=0.33), social integration (g=0.31), and cognitive performance (g=0.24). Most effects were maintained at follow-up. We observed larger improvements of depressive symptoms in depressed individuals (g=1.09) and persons with chronic physical disease (g=0.94) than in other individuals, and in those receiving life-review therapy (g=1.28) rather than life-review or simple reminiscence. Moderating effects of the control condition were also detected.

CONCLUSIONS

Reminiscence interventions affect a broad range of outcomes, and therapeutic as well as preventive effects are similar to those observed in other frequently used interventions.