CRITICALLY APPRAISED PAPER (CAP) Meléndez-Moral, J., Charco-Ruiz, L., Mayordomo-Rodriguez, T., & Sales-Galán, A. (2013). Effects of a reminiscence program among institutionalized elderly adults. Psicothema, 25(3), 319 323. http://dx.doi.org/10.7334/psicothema2012253 CLINICAL BOTTOM LINE: Elderly adults, particularly those experiencing institutionalization (permanent residence in a health care facility), face high rates of depression, low self-esteem, and reduced psychological well-being. Reminiscence therapy, the planned use of stimuli to evoke meaningful or positive memories from the past, has been indicated in prior research to be a promising treatment approach for reducing depressive symptoms among institutionalized elderly adults. The authors of this study evaluated the effectiveness of 8 60-minute reminiscence therapy sessions on improving mental health and psychological well-being in a sample of institutionalized elderly adults. Following the, the treatment group had significantly lower depressive symptomatology and significantly higher scores on self-esteem and life satisfaction measures. The control group showed no improvement on the self-esteem and life satisfaction measures and actually experienced more depressive symptoms during the posttest. The results provide preliminary evidence that reminiscence therapy may be an effective for improving depressive symptoms and increasing self-esteem and life satisfaction among institutionalized elderly adults. The study was not robust enough to warrant implementation of reminiscence therapy into occupational therapy practice at present. However, reminiscence therapy presents a promising research topic for occupational therapists working within mental health and healthy aging practice areas. RESEARCH OBJECTIVE(S) List study objectives. Evaluate the usefulness of reminiscence therapy for improving emotional health and psychological well-being in institutionalized elderly adults DESIGN TYPE AND LEVEL OF EVIDENCE: Level II: Quasi-experimental, single-blind design 1
SAMPLE SELECTION How were subjects recruited and selected to participate? Please describe. The authors selected two retirement homes in the Valencia province of Spain. The sampling technique used to select these two homes was not reported. Each home was randomly assigned to either the or the control status. The sampling criteria to select participants from the resident population of each home were not reported. Inclusion Criteria Elderly adults who participated in this study resided in one of the two selected retirement homes and were 65 92 years old. No other inclusion criteria were reported. Exclusion Criteria Elderly adults with a Mini-Mental State Examination (MMSE) score of less than 23 were excluded from the study. SAMPLE CHARACTERISTICS N = (Number of participants taking part in the study) = 34 #/ (%) Male Intervention: NR/16.7% #/ (%) Female Control: NR/44% Intervention: NR/83.3% Control: NR/56% Ethnicity ``````` NR Disease/disability diagnosis No specific disease or disability was reported. Participants were older adults living in retirement homes with no cognitive impairment. INTERVENTION(S) AND CONTROL GROUPS Group 1 Brief description of the How many participants in the group? Intervention consisted of 8 reminiscence therapy sessions, each aimed toward a different theme. Theme topics included transitioning through life stages, remembering games from childhood, popular songs, remembering grandmothers, holidays, and special days. The administrator deliberately introduced triggers at spontaneous intervals to elicit interpersonal-style story telling, which allowed participants to share their memories. Although 34 participants from two different retirement homes participated in this study, the number of participants in this particular group was not specified. 2
Where did the take place? Who delivered? How often? For how long? The retirement home where the participants reside A psychologist Frequency of sessions was not indicated beyond stating that a total of 8 separate sessions were held. The authors did not specify the duration of the study, but stated that each reminiscence therapy session lasted 60 minutes. Group 2 Brief description of the How many participants in the group? Where did the take place? Who delivered? How often? For how long? During the 8 sessions that the group was receiving therapy, members of the control group participated in activities they would normally participate in at their facility. Although 34 participants from two different retirement homes participated in this study, the number of participants in this particular group was not specified. At the retirement home where the participants resided, and the participants completed activities their community provided as normal. NR Frequency of sessions was not indicated beyond stating that a total of 8 separate sessions were held. The authors did not specify the duration of the study. Intervention Biases: Check yes, no, or NR and explain, if needed. Contamination: The authors reported that each retirement home was randomly assigned to either treatment or control status. The reader therefore deduces that because the treatment and control groups resided at different retirement homes, no contamination occurred. 3
Co-: NR Though not reported, it is not uncommon for residents in the retirement home to receive other such as medication and other group activities. Timing: NR The authors did not discuss the timeline of their, but did state that their results are similar to other research studies which reported lasting effects of reminiscence therapy up to 3 months after treatment. However, this study did not include a follow-up to determine the effectiveness of in their over time, so long-term effectiveness of the on participants psychological and emotional well-being is unclear. Site: The group and the control group both remained at their retirement facilities for the duration of the study, which can be considered equal site parameters. Tests for homogeneity showed no significant differences between the groups before the. Use of different therapists to provide : The reminiscence therapy took place in a group format with the same psychologist leading each session. Therefore, this study is not in danger of the bias of using different therapists for the group. MEASURES AND OUTCOMES Complete for each measure relevant to occupational therapy: Measure 1: Name/type of measure used: Mini-Mental State Examination (MMSE) Gauge cognitive level; MMSE score of <23 was used as exclusion criteria Is the measure reliable? NR Is the measure valid? NR When is the measure used? Twice, used as a screening for exclusion criteria as well as a pretest and posttest to determine effect of 4
Measure 2: Name/type of measure used: Mini-Geriatric Depression Scale (GDS) 8 Uncover depressive symptomatology Is the measure reliable? NR Is the measure valid? NR When is the measure used? Measure 3: Name/type of measure used: Twice, used as a pretest and posttest to determine effect of Geriatric Depression Scale (short-form, specifically adapted for institutionalized, elderly adults) Uncover depressive symptomatology Is the measure reliable? NR Is the measure valid? NR When is the measure used? Measure 4: Name/type of measure used: Twice, used as a pretest and posttest to determine effect of Rosenberg Self-Esteem Scale Record individual expression of self-esteem Is the measure reliable? NR Is the measure valid? NR When is the measure used? Measure 5: Name/type of measure used: Twice, used as a pretest and posttest to determine effect of Philadelphia Geriatric Center Morale Scale Record individual expression of life satisfaction Is the measure reliable? NR Is the measure valid? When is the measure used? YES, but value not reported Twice, used as a pretest and posttest to determine effect of 5
Measure 6: Name/type of measure used: Ryff scales Gauge psychological well-being Is the measure reliable? NR Is the measure valid? YES, but value not reported When is the measure used? Twice, used as a pretest and posttest to determine effect of Were the evaluators blind to treatment status? Check yes, no, or NR, and if no, explain. NR Recall or memory bias. Check yes, no, or NR, and if yes, explain. YES Others (list and explain): Most of the outcome measures used relied on self-report or subjective measures, indicating that recall or memory bias are potential threats to validity in this experiment. RESULTS List key findings based on study objectives Include statistical significance where appropriate (p < 0.05) Include effect size if reported No significant differences existed between treatment and control groups on the pretest of cognition; comparison of pre- and posttest scores of the control group revealed significantly lower measures at posttest (M1 = 26.77, M2 = 26.38), F (1, 24) = 5.08, p <.034, ƞ² =.175. When cognition scores were analyzed for within-subjects effects of time group interaction, no significant differences were found. Depression scores for the treatment group were significantly lower post-treatment (M = 2.46) than pre-treatment (M = 3.46), F (1, 27) = 5.40, p =.028, ƞ² =.167. Conversely, an increase in depression scores was seen in the control group (M1 = 2.37, M2 = 2.62). Results also revealed a significant increase in the treatment group s two self-esteem scores, F(1, 24) = 76.87, p <.000, ƞ² =.403. Moreover, the overall self-esteem scores for the control group remained stable over time (M1 2 = 32.60), while the treatment group s self-esteem scores increased (M1 = 34.30, M2 = 35.46). On the life satisfaction assessment, a significant increase in scores was found in the treatment group, (M1=6.61, M2=11.69), F(1,27) = 76.87, p <.000, ƞ² =.762, while the scores for the control group increased only slightly (M1 = 7.91, M2 = 8.07). Furthermore, the treatment group had significant improvements in four measurements of psychological well-being, including self-acceptance F (1, 24) = 9.91, p =.004, ƞ² =.293; positive relations with others F (1, 24) = 8.37, p =.007, ƞ² =.269; personal growth F (1, 24) =8.15, p = 6
.009, ƞ² =.254; and purpose in life F (1, 24) = 28.36, p <.000, ƞ² =.542. The control group had significant differences in measures of environmental mastery, F (1,24) = 14.4, p <.001, ƞ² =.369 and autonomy F (1,24) = 13.82, p <.001, ƞ² =.365, with scores decreasing at posttest. Overall, the results showed that elderly adults in the treatment group experienced more emotional and psychological benefits than those in the control group. Was this study adequately powered (large enough to show a difference)? Check yes, no, or NR, and if no, explain. The sample size was small. Were appropriate analytic methods used? Check yes, no, or NR, and if no, explain. YES Were statistics appropriately reported (in written or table format)? Check yes or no, and if no, explain. YES Was the percent/number of subjects/participants who dropped out of the study reported? Limitations: What are the overall study limitations? Limitations of this study include a small sample size and a lack of results pertaining to the relationship between number of treatment sessions and outcomes. Thus, it is difficult to determine whether results improve directly as a result of more treatment sessions. Another limitation of this study was a lack of research regarding the sustained effect of the. Lastly, the outcome measures were primarily self-report or subjective measures of well-being, indicating that recall and memory bias may have skewed results. CONCLUSIONS State the authors conclusions related to the research objectives. This study demonstrated the effectiveness of reminiscence therapy to improve various measures of emotional and psychological well-being among institutionalized elderly adults. Participants in the treatment group received 8 60-minute sessions of reminiscence therapy. These participants had a significant decrease in depressive symptomatology and significant improvements in self- 7
esteem scores and life satisfaction. Additionally, participants who received reminiscence therapy experienced improvements in multiple aspects of psychological well-being. Although this study found that reminiscence therapy may benefit elderly adults on multiple emotional and psychological levels, the generalizability of the results is questionable due to the small sample size. To determine the accuracy of the results, it would be advantageous for future research to further examine the effects of reminiscence therapy with a larger sample size. In addition, future research can investigate how the number of reminiscence therapy sessions affects the longevity of results by implementing longitudinal studies. Finally, future research also may benefit from investigating the effects of reminiscence therapy on objective health outcomes such as number of hospitalizations, number of falls, or other behavioral measures. This work is based on the evidence-based literature review completed by Julie Bergen, OTS; Vincent O Brien, OTS; Tamara Vileshina, OTS; and Kitsum Li, OTD, OTR/L, Faculty Advisor, Dominican University of California. CAP Worksheet adapted from Critical Review Form--Quantitative Studies. Copyright 1998, by M. Law, D. Stewart, N. Pollack, L. Letts, J. Bosch, & M. Westmorland, McMaster University. Used with permission. For personal or educational use only. All other uses require permission from AOTA. Contact: www.copyright.com 8