Reminiscence is defined as ‘a method or technique to recall past memories’ (Westerhof et al, 2010:698). Reminiscence intervention is used to promote positive feelings in older adults as they share life experiences through recall of past events. The fundamental elements of a reminiscence intervention include organisation, facilitation, focusing on positive memories and discussion of themes from a generational perspective (Stinson, 2009). Often, reminiscence programmes for older adults involve the use of stimulating materials, such as old pictures, songs, household items and newspapers, and sharing the individuals' past memories. Despite variations, general themes such as participants discussing personal memories, discussion of historical objects and facilitated group discussion remain consistent in reminiscence programmes throughout the literature (Brooker and Duce, 2000; Watt and Cappeliez, 2000; Bohlmeijer et al, 2008; Stinson, 2009; Gallagher and Carey, 2012; Smiraglia, 2015; Soniya, 2015). Reminiscence programmes have been shown to improve cognitive and social skills in older adults, as an individual's past contributes to a rich base for formulating cognitive interpretations and motivational direction (Ertel et al, 2008).
O'Philbin and colleagues recently conducted a systematic review that focused on reminiscence therapy and health outcomes in older adults with dementia (O'Philbin et al, 2018). However, many older adults without dementia live in the community. Although reminiscence intervention has been studied in the past, few studies have focused on possible physiological health outcomes following multiple sessions. Given their potential positive effects on older persons' mental health, the role of reminiscence intervention programmes in successful ageing warrant further consideration. Many older adults experience challenging circumstances, such as changes in socio-economic status, declining physical health and the death of a spouse and/or loved ones. They also experience psychosocial health problems through the ageing process, such as depressive symptoms, loneliness, anxiety and reduced health-related quality of life (Stinson and Kirk, 2006; Stinson, 2009). Reminiscence intervention and similar interventions might have a positive influence on the overall wellbeing of older adults, which must be evaluated.
Therefore, the present integrative review of the literature seeks to examine the health outcomes of reminiscence intervention for older adults without dementia.
Reminiscence therapy has been used to assist people without dementia to review their life experiences, with an emphasis on bringing unresolved conflicts into conscious awareness (Cook, 1984). Reminiscence therapy is listed as a nursing intervention in the US-based nursing intervention classification (NIC) system, which is an evidenced-based nursing intervention system focusing on producing the best outcomes for clients and their families (Butcher et al, 2018). This therapy may be administered to a group or individual (Stinson, 2009).
Aim
The aim of this integrative review of the literature is to summarise empirical evidence supporting the health benefits of reminiscence intervention for older adults without dementia who reside in community and long-term care settings.
Theoretical framework
Guiding this review is the theory of culture: as older adults recall and share, they may experience a sense of belonging through their reminiscing experiences (Münch and Smelser, 1992). The theory of culture posits that an individual's past cultural influence(s) may have significant effect on physiological aspects of their life. An individual's society and heritage comprise symbols and interactions that may have significant meaning for the individual, and individuals share a sense of belonging with those from a similar generation or geographic region.
Methods
Garrard's matrix method was used to conduct this integrative literature review (Garrard, 2014). The process includes formulating the problem and purpose, searching the literature, screening and selecting scientific papers, evaluating the quality of the studies, analysing and integrating the benefits of studies, interpreting and summarising the evidence, drawing conclusions based on the evidence and presenting results. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) process was applied to guide the selection of studies (Moher et al, 2009) (Figure 1).
Search methods
An electronic search was completed using the following databases for studies published between 2000 and 2019: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature On-Line (MEDLINE), Academic Search Complete and PsycInfo.
A preliminary review of relevant search terms revealed that the term ‘reminiscence intervention for older adults’ yielded limited results within the databases. Therefore, the key search terms for CINAHL were modified to MH ‘reminiscence’ AND ‘older adults’ or ‘seniors’ or ‘geriatrics’ or ‘aging’; those for MEDLINE were MH ‘reminiscence’ and ‘older adults*’; those for Academic Search Complete were MH ‘reminiscence’ AND ‘older adult’; and those for PsycInfo were MH ‘reminiscence’ AND ‘older adults’ or ‘elderly’ or ‘seniors’ or ‘geriatrics’.
Inclusion and exclusion criteria
The inclusion criteria used were: individual or group reminiscence as an intervention; participants over 65 years of age living in community, long-term care, assisted-living and/or nursing home settings; reporting of physical, psychological and/or social health outcomes; and randomised controlled trials (RCTs) and quasi-experimental, observational, correlational and/or qualitative studies as study types. The exclusion criteria were: interventions focused on health professionals or students, studies; those focused on the development or evaluation of a reminiscence intervention without reporting health outcomes; those including people with a diagnosis of dementia; systematic reviews; and non-English language manuscripts. Further, secondary references were excluded.
Search outcomes
CINAHL yielded 277 results, MEDLINE yielded 161 results, Academic Search Complete yielded 182 results and PsycInfo yielded 402 results. The abstract or full-text of these papers was reviewed for the inclusion criteria. A detailed audit trail, including key words, databases and field notes, was maintained electronically.
Quality appraisal
Using the approach outlined by Melnyk and Fineout-Overholt (2015), each study that met the inclusion criteria was critically appraised. Each study was assessed for strengths, limitations and relevance to clinical practice. Seven criteria were applied in the critical appraisal, including the purpose/aim, sample size, setting, validity and reliability of measurement, data analysis, confounding events occurring in the study, fit of the results within the context of the present research and clinical relevance (Melnyk and Fineout-Overholt, 2015). A quality score, ranging from 0 to 7, was assigned to each study included. Data were evaluated from the studies and critical elements from each study were extracted.
Results
A total of 1022 results were generated from a search of the four databases, and one full-text article was generated through a manual search. Duplicates were removed (638), and 384 abstracts were screened for the inclusion and exclusion criteria. Some 317 records were excluded based on the exclusion criteria. Then, 67 full-text articles were systematically evaluated for inclusion in the literature review, of which 52 studies were excluded based on the exclusion criteria. Finally, one qualitative and 14 quantitative studies were included in the review (Figure 1).
Study characteristics
The 15 studies that met the inclusion criteria had a total of 815 participants (Appendix 1). Six studies were conducted in nursing homes, four in community-dwelling settings, four in retirement/assisted-living facilities and one in a community health centre. Nine studies were assigned a quality appraisal score of 7, three studies were assigned a score of 6 and three were assigned a score of 5.
Nine studies implemented group reminiscence interventions (Watt and Cappeliez, 2000; Westerhof et al, 2004; Karimi et al, 2010; Melendez-Moral et al, 2012; Haslam et al, 2014; Smiraglia, 2015; Soniya, 2015; Lopes et al, 2016; Hanaoka et al, 2018; Satorres et al, 2018; Siverova and Buzgova, 2018), while three studies implemented individual reminiscence interventions (Bohlmeijer et al, 2008; Gallagher and Carey, 2012; Henkel et al, 2017). Six health outcomes of reminiscence intervention were identified for older adults residing in community and long-term care settings: reduced depressive symptoms (Watt and Cappeliez, 2000; Karimi et al, 2010; Melendez-Moral et al, 2012; Soniya, 2015; Lopes et al, 2016; Henkel et al, 2017; Siverova and Buzgova, 2018); wellbeing, peace or life satisfaction (Gallagher and Carey, 2012; Melendez-Moral et al, 2012; Haslan et al, 2014; Smiraglia, 2015), quality of life (Westerhof et al, 2004; Bohlmeijer et al, 2008), social engagement (Bohlmeijer et al, 2008; Satorres et al, 2017; Siverova and Buzgova, 2018), reduced anxiety (Haslam et al, 2014; Lopes et al, 2016), cognitive/memory improvement (Hanaoka et al, 2018; Lopes et al, 2016; Siverova and Buzgova, 2018). This integrative review found that significant improvements in depressive symptoms were the most significant health outcome associated with reminiscence intervention. Depressive symptoms in older adults often have a negative impact, such as fatigue, sleep disturbance and thoughts of self-harm or suicide (Dahlkemper, 2016). Therefore, prevention and treatment of these symptoms remains imperative. Additionally, Hanaoka et al (2018) found significant improvements in post-reminiscence intervention memory recall skills in community-dwelling older adults.
Discussion
The most significant health outcome of reminiscence intervention revealed was improvements in depressive symptoms (Soniya, 2015; Melendez-Moral et al, 2012). Ciechanowski et al (2004) also found that socialisation and peer group activities resulted in a significant decrease in depressive symptoms among older adults. Depression is a serious problem for older adults in the community, as it may be associated with further exacerbation of reduced physical capabilities and decreased independence with activities of daily living (Cahoon, 2012).
The findings of this study regarding the other health outcomes of reminiscence intervention are similar to those of O'Philbin et al (2018), who identified improvements in cognition, mood and communication following reminiscence intervention among participants with a diagnosis of dementia. Thus, such meaningful activities have potential to produce mental and psychosocial health outcomes for community-dwelling older adults.
Although positive outcomes were a significant theme in this review, Henkel et al (2017) identified certain negative aspects of individual reminiscence intervention, including lower morale, an increase in depression symptoms and increased loneliness. As participant recalls memories and past life events, negative ones can also come to the forefront, and this would naturally hamper their overall wellbeing (Hofer et al, 2017). Participants' thoughts and feelings of bitterness, boredom, despair and hopelessness may contribute to the negative health outcomes associated with self-reminiscence intervention. Thoughtful attention is recommended when using individual reminiscence intervention with older adults. Further, it remains imperative to reinforce approaches to validate reminiscence interventions to preclude unintended health consequences in older adults without dementia (Hofer et al, 2017:393).
Hanaoka et al (2018) revealed that older adults had significant memory recall skills following multi-session, group reminiscence intervention. Improvements in memory and cognitive abilities are encouraging and may be significant in preventing cognitive decline in ageing older adults.
Relevance to practice
Reminiscence intervention has the potential to maintain and/or increase the physiological and psychosocial health and wellbeing of older adults. Offering cognitive and socially engaging activities for older adults in long-term care facilities or in the community remains imperative to promote ageing in place. Reminiscence programmes can be created, or pre-existing programmes may be implemented. For community nurses, promotion of functional independence and prevention of negative mental and psychosocial health outcomes in older adults are important objectives. Nurses in the community may be involved in the development of reminiscence programmes for older adults; therefore, it is essential for them to understanding evidenced-based reminiscence intervention.
Ongoing research needs to examine the effects of reminiscence intervention in preventing cognitive and social decline in older adults (Ertel et al, 2008), especially dementia.
Conclusion
Reminiscence intervention may be implemented for older adults residing in the community and may be considered a meaningful activity with positive health-related outcomes. As it has shown good outcomes in terms of improving memory and cognitive skills, continued research with older adults without dementia syndrome is needed to further substantiate the association between memory recall skills and reminiscence intervention. Reminiscence intervention may offer a viable approach to physical and/or mental health challenges encountered by older adults. As researchers explore mental health conditions and dementia-associated diseases, reminiscence intervention may have purpose in early management as a non-pharmacological approach that contributes to a rich base for reformulating cognitive interpretations and increases cognitive abilities and improves social skills in older adults.