Referentes teóricos iniciales de MPSC

Reminiscence therapy for older adults is a technique that is designed to help older adults resolve conflicts and accept their successes or failures. It is generally provided in long-term care facilities, senior housing, and senior community centers by trained nurses and therapists. It is effective in treating mild levels of depression. Technical assistance and published protocols are available.

Description of Intervention

Reminiscence therapy involves the discussion of past activities, events and experiences with another person or group of people. It can be provided in many forms in order to prevent, assess, and intervene with depression and other mental health issues. Structured reminiscence approaches include Life Review and Guided Autobiography. The concept of Life Review was published by Robert N. Butler in 1963. The life review process helps older adults resolve conflicts and accept both the successes and failures of their lives. In the life review process, practitioners use weekly topics to guide older adults in recalling memories from different stages of their lives and to stimulate discussion of major life events. These processes are thought to promote feelings of control over past and present life events by counteracting learned helplessness.

Guided Autobiography was developed by James Birren during the 1960s. It uses a group process with written assignments. Participants discuss significant turning points in their lives to gain additional insight about their life experiences. Weekly sessions are guided by themes that include family history, life accomplishments, life turning points, stressful experiences, and the meaning

Structured reminiscence therapy is typically provided in a group setting, led by a mental health practitioner, and occurs over four to twelve weekly sessions that last 60–90 minutes.

There are several potential benefits of reminiscence approaches.

n Reminiscence approaches can be used during the assessment process to bolster older adults’ confidence and self-esteem.

n _{Reminiscence can be integrated into a number} of treatment approaches, including cognitive behavioral therapy. These approaches are effective in individual, group, marital/family, and milieu therapy modalities.

n Practitioners can use reminiscence materials to develop therapeutic resource states that facilitate change.

n Reminiscence approaches can help obtain and maintain attention and rapport for those who want to educate older adults about mental health issues.

Practitioners

Reminiscence therapy can be provided by practitioners who have received training in reminiscence therapy. Practitioners can include mental health professionals, nurses, chaplains, and other members of a multi-disciplinary team. Practitioners should integrate their reminiscence approaches within their theoretical approach and treatment plan.

Diagnoses or Disorders Addressed n Major Depression

n _{Depressive symptoms, as indicated by a} Geriatric Depression Scale (GDS) score of 14 or greater, or 16 or greater on the CES-D. Reminiscence therapy has been used to prevent and assess mental health disorders. It has been used in older adults with anxiety and health conditions that cause anxiety; behavioral problems due to dementia, delirium, or other physical health disorders; normal and unresolved grief; and substance abuse. Reminiscence therapy also has been tested in older adults with dementia.

Evidence and Outcomes

n _{Four randomized controlled trials have been} conducted by multiple researchers.

Reminiscence therapy is effective in reducing depressive symptoms of older adults, compared to a waitlist or no treatment. Reminiscence therapy also can reduce hopelessness, reduce functional disability, and improve life satisfaction.

Outcomes of reminiscence therapy have been mixed in studies where older adults did not have a diagnosis of major depression, with some studies supporting reminiscence therapy and some finding no benefits.

Reminiscence therapy is less effective than problem solving treatment and goal- focused psychotherapy.

Settings of Research

n Outpatient medical treatment facilities n Hospitals

n Assisted living and long-term care facilities n _{Retirement apartments}

n _{Senior community centers}

Reminiscence therapy can be delivered in group or individual sessions.

Populations Included in Research

Studies of reminiscence therapy included older adults of both genders, though most participants were female (range: 54–83%). Participants were age 55 and older in two studies, 60 and older in one study, and 65 and older in one study. The amount of research on reminiscence

approaches is growing rapidly. Data supports the effectiveness of reminiscence therapy among racial and ethnic minority groups and frail older adults.

Training and Resources Available

Manual Availability

Reminiscence therapy is based on the model developed by Butler (1963). A published protocol for delivering reminiscence therapy (Birren & Deutchman, 1991) has been developed and is available in bookstores and online (e.g., http://www.amazon.com for $25). However, formal protocols for delivering reminiscence therapy that clearly identify the essential components of this intervention are needed.

n _{Butler, R. N. (1963). The life review: an} interpretation of reminiscence in the aged.

Psychiatry. 26(1), 65–76.

n Birren, J. E., & Deutchman, D. E. (1991).

Guiding Autobiography Groups for Older Adults. Baltimore, MD: Johns Hopkins University Press.

Several books and reference manuals describe the theory and applications of reminiscence therapies. n _{Gibson, F. (2004). The Past in the Present: Using}

Reminiscence in Health and Social Care. Health Professions Press.

n _{Haight, B. K. (1995). The Art and Science of}

Reminiscing: Theory, Research, Methods, and Applications. Washington DC: Taylor & Francis. n Haight, B. K., & Haight, B. S. (2007). _The

Handbook of Structured Life Review. Health Professions Press.

n _{Kunz, J. A., & Soltys, F. G. (2007).}

Transformational Reminiscence: Life Story Work. New York: Springer Publishers.

n Webster, D. J., & Haight, B. K. (2002). _Critical

Advances in Reminiscence Work: From Theory to Application. New York: Springer-Verlag

Videos

n Kunz, J. A. (2002). _{The Joys and Surprises of}

Telling Your Life Story. University of Wisconsin Board of Regents.

n _{Kunz, J. A. (1997). Therapeutic Reminiscence.} Video tape and work book. Mental Health Outreach Network.

Internet Resources

n _{Arigho, B. How to Help Reminiscing}

Go Well. Principles of Good Practice in Reminiscence Work. Age Exchange. London. http://www.age-exchange.org.uk/our_work/ publications/index.html.

n _{International Reminiscence and Life} Review Conference. (2007). Proceedings and Selected Papers. Published in English, Japanese, and Spanish. Available from: http://reminiscenceandlifereview.org.

n _{Mapping Memories: Reminiscence with Ethnic}

Minority Elders. Age Exchange. London.

Including Chinese, African, Caribbean, and Asian older adults. Available at:

Training and Technical Assistance Customized training is available for key note lectures, workshops and other consultation from the International Institute for Reminiscence and Life Review. The goal of this institute is to provide education on reminiscence and life review practice, research, and ways to integrate the material in formal education, staff training, and volunteer organizations. Membership in the Institute provides access to a private list- serve that allows for consultation with experts in the field. The institute can be accessed at: http://reminiscenceandlifereview.org

Replications and Adaptations

Reminiscence work is popular in Japan and across Europe with many diverse populations. Programming and research also has been conducted within the United States. Systematic reviews have recommended the need for additional rigorous studies of the effectiveness of reminiscence therapy in older adults with depression.

Key Issues Related to Implementation

Location: Group and individual sessions of reminiscence therapy require minimal space or resources. Reminiscence therapy should be sensitive to the different needs of older adults. Reminiscence therapy should be provided in a location that can accommodate the needs of older adults, including settings that are bright, have comfortable seating, and are free from outside disturbances.

Other issues: Practitioner training is needed prior to implementing reminiscence training. It is an easily implemented intervention that is considered part of a normal developmental process (Jones and Beck-Little, 2002).

Program Contact Information

Information can be obtained through the International Institute for Reminiscence and Life Review: Center for Continuing Education/ Extension at the University of Wisconsin-Superior. John Kunz, M.S.

Center for Continuing Education/Extension University of Wisconsin-Superior

Belknap & Catlin Ave, PO Box 2000 Old Main 102 Superior WI 54880-4500 Phone: (715) 394-8469 E-Mail: [email protected] Internet: http://reminiscenceandlifereview.org

References

Comparisons with psychotherapies or control group

Areán, P. A., Perri, M. G., Nezu, A. M., et al. (1993). Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. Journal of Consulting and Clinical Psychology, 61(6), 1003–1010.

Klausner, E. J., Clarkin, J. F., Spielman, L., et al. (1998). Late-life depression and functional disability: The role of goal-focused group psychotherapy. International Journal of Geriatric Psychiatry, 13, 707–716.

Serrano, J. P., Latorre, J. M., Gatz, M., et al. (2004). Life review therapy using

autobiographical retrieval practice for older adults with depressive symptomatology.

Psychology and Aging, 19, 272–277.

Watt, L. M., & Cappeliez, P. (2000). Integrative and instrumental reminiscence therapies for depression in older adults: Intervention strategies and treatment effectiveness.

Aging and Mental Health, 4, 166–177.

Other relevant references

Butler, R. (1974). Successful aging and the role of life review. Journal of the American Geriatric Society, 22, 529–535

Jones, E. D., & Beck-Little, R. (2002). The use of reminiscence therapy for the treatment of depression in rural-dwelling older adults. Issues in Mental Health Nursing, 23, 279–290.

Kunz, J. A. (2002). Integrating reminiscence and life review techniques with brief, cognitive behavioral therapy. In Webster JD, Haight BK (Eds.), Critical advances in reminiscence work: From theory to applications (pp. 275–288). New York: Springer-Verlag.