Reviving memories, revitalizing minds: The impact of group reminiscence therapy on well-being of elderly residents in care facility

ABSTRACT

Background and Objectives:

Group reminiscence therapy has shown potential in improving the mental well-being of older adults. The present study aimed to assess the mental health of older adults in selected elderly care facilities in the urban part of north Tamil Nadu to evaluate the effectiveness of group reminiscence therapy and identify the association of their mental well-being with sociodemographic factors.

Methods:

Using a convenience sampling method, a quasiexperimental pretest–posttest study was conducted over a 6-week period. It included 30 participants from one elderly care facility for the experimental group and 30 from two other homes (12 and 18 participants, respectively) as the control group, all meeting specific inclusion criteria. During the first week, sociodemographic data of the participants were collected, and their mental health was assessed using the General Health Questionnaire-12. Reminiscence therapy was provided to the experimental group from the 2^nd to the 5^th week. A posttest was conducted for both the groups during the 6^th week to assess the participants’ mental health.

Results:

The experimental group showed a male preponderance from urban habitat, whereas the control group was dominated by women from rural background. The study revealed that most participants in both the experimental groups (26/86.7%) and control groups (29/96.7%) were distressed at the beginning of the study. Following the reminiscence therapy, twenty-three (76.7%) residents in the experimental group showed a significant and reassuring improvement in mental health.

Interpretations and Conclusions:

The distress identified during pretest underscores the significant mental health challenges faced by older adults. Reminiscence therapy has an important role in promoting mental health of older adults. This study reinstates the potential of reminiscence therapy in improving their quality of life. Longitudinal, community-based studies are required to extend the significance of the therapy.

Introduction

In this fast-paced modern world, older adults may feel overlooked in terms of technology and the valuable wisdom gained through years of experience can be undervalued. Reminiscence therapy bridges this gap by reaffirming the significance of their life, experiences, and wisdom. Reminiscence is defined as the process of thinking or telling someone about past experiences that are personally significant.[1]

Reminiscence therapy is a powerful therapeutic approach that uses the act of recalling past experiences to enhance mental and emotional well-being. Different forms of reminiscence are available, namely, simple, life review, and life review therapy. Simple reminiscence is the recollection of personal memories and shared stories. Life review involves structured sessions with a therapist to explore the client’s life experiences and their overall meaning. Life review therapy is a specialized therapeutic approach aimed at helping clients who are struggling to cope with specific events from their past. Information reminiscence is the form of recollection and sharing of old memories for the pleasure of reliving.[2] This could be done in two ways either individually (intrapersonal) or as a group (interpersonal).[3] This psychological intervention has been widely used in patients with geriatric depression or dementia. Multiple studies were done using this therapy in elderly with depression and dementia. Nevertheless, there is a scarcity of studies examining the therapy’s effectiveness on the mental health and psychological well-being of older individuals.[4,5]

Objective of the study

The present study focused on examining the efficacy of group reminiscence therapy on the mental health and psychological well-being of elderly individuals. The primary objective was to evaluate the mental health of elderly care facility residents and to determine the impact of group reminiscence therapy on their mental health outcomes. In addition, the study sought to identify the factors associated with their psychological well-being.

Methods

Setting

Three elderly care facilities in and around the urban part of North Tamil Nadu were selected. One home with a capacity of 30 inmates. The second and the third home had a capacity of 12 and 18, respectively.

Permission

Necessary permission was obtained from the concerned authorities of the elderly care facility. Ethical clearance was obtained from the institutional review board (IRB 14464 INTERVEN) and the college ethical committee.

Design of the study

A quasiexperimental pretest–posttest study[6] was done to determine the effectiveness of group reminiscence therapy on the level of mental health of residents of selected elderly care facilities in the urban part of north Tamil Nadu.

Inclusion and exclusion criteria

Residents of the selected elderly care facilities who were between 60 years and 85 years, with intact cognition and memory, and were residents of the care home for at least 3 months were selected for the study. Residents with known mental illness, dementia, or intellectual disability were excluded.

Sample size calculation

Based on a previous study done in the same institution, the percentage improvement in the mental health of patients who received and did not receive reminiscence therapy is 43% and 7%, respectively.[7] With 90% power and 5% error, the required sample size required was 30 participants each for both the groups.

Period of the study

From mid of July 2023 to August 2023.

Place of the study

The data were collected from residents of three selected old age homes in urban part of north Tamil Nadu. Purposive sampling technique was used. One home with a capacity of 30 inmates was selected as the experimental group, and two others, with a capacity of 12 and 18, formed the control group.

Instruments used

The general health questionnaire-12 (GHQ-12)[2] is the shortest version of the GHQ, widely used to detect nonpsychotic psychiatric illness in busy clinical settings. It can also be used for subjects who are illiterate. There are three ways of scoring the GHQ-12: the bimodal GHQ scoring method (0-0-1-1), the Likert scoring method (0-1-2-3), and the C-GHQ scoring method where positively phrased items are scored (0-0-1-1) and negatively phrased items (0-1-1-1). The binary scoring method was used in this study.

Procedure for data collection

Consent

Formal information along with the information sheet about the study was given to the inmates of the old age home residents, and written informed consent was obtained.

The flow chart of the study is depicted in Figure 1.

Figure 1.

Flowchart of the study

Pretest

The study was conducted over a 6-week period. In the first week, demographic data were collected, and the level of mental health was assessed using the General Health Questionnaire-12 for both groups.

Intervention for the experimental group

Reminiscence therapy: (2^nd week to 5^th week).

The experimental group was engaged in a structured 60-minute daily session of reminiscence therapy for 4 weeks that focused on specific themes. Each theme was delivered over a period of 2 to 3 days, encompassing a total of six selected topics: music, festival celebrations, cuisine and culinary practices, transportation, childhood games, and occupational experiences. Each participant was given an opportunity to articulate their recollections. The use of instructional aids such as flip charts, videos, and audio recordings served to enrich the therapeutic experience throughout the 4-week duration.

TOPICS FOR REMINISCENSE THERAPY:[7]

• 1)MUSIC: Discussion was on various subtopic which included method of music system used (radio, recorder, radio room), type of music (melody songs, fast songs, film/devotional songs, folk songs, drama songs), favourite singer, and favourite song.

  To assist the discussion, internet facility was used to play various songs from the 1950s to 1970s. The patients were asked to identify the songs, name their favorite ones, and were encouraged to sing them as well. The researcher also sung a few of the common songs.

• 2)Festival celebration with subtopics of various festival celebrated by them, method of celebration, special preparation made for the celebrations, and rituals related to celebrations were discussed.

  Assisted by images and videos of various celebrations, the topic encouraged them to talk about various stories behind the celebrations.

• 3)CUISINE AND CULINARY PRACTICES: Name of the food, their likes and dislikes, cost of food items, method of cooking (vessels, fuels), common food items, and the process of cooking were some topics covered. Discussion was assisted by videos. Women could share some common and rare recipes prepared by them and their health benefits, where in men shared their likes and dislikes.
• 4)TRANSPORT: The discussion was focused on different modes of transport used, expense of transport, the condition of the roads, and the mode of transport of goods. Videos and images were used as props.
• 5)GAMES OF CHILDHOOD: Subtopics for the discussion were memorable and funny experience with childhood friends, common games played (kabaddi, playing with pebbles, kite flying), materials used for playing, groups involved in play (male/female, senior/junior), play companions (siblings, school mates, neighbourhood friends), and play timings. It was assisted by bringing available play items, showing the images of the play items, and playing video of common games of their period. Participants demonstrated few games to the group.
• 6)WORK AND WORK PATTERN IN THEIR TIME: The timings of work, nature of work, working pattern and the wages and financial details were discussed. Images were used as props.

The principal investigator of the study served as a facilitator for the group by taking on a leadership role for the first one or two sessions to initiate the conversation. This involved guiding the discussion, encouraging participation, and ensuring everyone felt included. Videos, song audio files, and a variety of visual aids such as magazines and flip charts were used in the session.

Control group

The control group was provided with pertinent health education regarding common health problems, tailored to the specific requirements of elderly individuals residing in elder care facilities. Health education was given regarding self-care, hygiene, dietary advice, and on common health problems like diabetes and hypertension.

Posttest

A posttest was administered to both the experimental and control groups using the GHQ-12 assessment to measure the level of mental health in the 6^th week.

The data collected were entered and analyzed using SPSS VERSION 21.0.

Statistical analysis

All categorical variables were reported using frequency and percentages, and continuous variables were reported using mean (SD) or median (IQR). Pearson Chi-square test or fisher exact test was used to check the association between the categorical variables. A P value of < 0.05 was considered statistically significant. All analysis is performed using statistical software SPSS version 21.0.

Results

Distribution of subjects according to demographic variables

Majority of the residents in experimental and control group were more than 70 years old, who had completed primary school education from a Hindu background.

The experimental group showed a male preponderance from urban habitat, whereas the control group was dominated by women from rural background.

The demographic details of the participants are given in Table 1.

Table 1.

Demographic details of the participants

Demographic variables		Experimental (n=30)		Control (n=30)
		Frequency (n)	Percentage %	Frequency (n)	Percentage %
Age	60-64 years	6	20	6	20.0
	65-69 years	4	13.3	10	33.0
	>07 years	20	66.7	14	46.7
Gender	Male	17	56.7	6	20.0
	Female	13	43.3	24	80.0
Educational Status	Illiterate	7	23.3	10	33.3
	Primary	12	40.0	20	66.7
	Higher secondary	5	16.7	0	0
	Graduate and above	6	20.0	0	0
Marital status	Single	10	33.3	13	43.3
	Married	7	23.3	1	33.3
	Widow/widower	11	33.3	16	53.3
	Separated	2	6.7	0	0
Duration of stay	<1 year	1	3.3	2	6.7
	1-2 years	8	26.7	16	53.3
	3-4 years	9	30.0	10	33.3
	>5 years	12	40.0	2	6.7
Monthly allowances	None	9	30	23	76.7
	Below 1000	8	26.7	6	20.0
	1001-000	6	20.0	1	3.3
	Above 3001	7	23.3	0	0
Relative’s visit	Annual	11	36.7	0	0
	Weekly	1	3.3	0	0
	No visits	7	23.3	18	60
	Special days	11	36.7	12	40

Mental health of the participants across the study period

Figure 2 depicts the level of mental health of residents of elderly care facilities before reminiscence therapy (pretest). Participants in both the experimental and control groups were distressed, and no significant difference was found between the groups.

Figure 2.

Distribution of level of mental health of residents of old age home before the intervention

However, following reminiscence therapy, there was a significant improvement in the mental health of participants in the experimental group and they reported being less distressed. This is depicted in Figure 3 and Tables 2 and 3.

Figure 3.

Distribution of level of mental health of residents of old age home after the intervention

Table 2.

Table showing the comparison of mental health of the participants before and after reminiscence therapy

Groups		Experimental n (%)	P	Control n (%)	P
Pretest	Normal	4 (13.3)	0.53	1 (3.3)	<0.001
	Distressed	26 (86.7)		29 (96.7)
Post test	Normal	23 (76.7)		0 (0)
	Distressed	7 (23.3)		30 (100)

Table 3.

Changes in the mental health level pre and post reminiscence therapy among the groups

Groups	Pretest		Post test		Paired sample		95% CI		P
	Mean	SD	Mean	SD	Mean	SD	Lower	Upper
Experimental	6.67	2.04	3.20	1.54	3.46	2.58	2.502	4.431	<0.001
Control	6.20	1.42	7.83	1.48	-1.6	2.141	-2.433	-0.834	<0.001

By using binomial distribution, Fishers exact test P value < 0.001.

Out of the 26 participants who reported feeling distressed in the pretest, it is notable that 19 of them, amounting to 63.3%, displayed improved psychological well-being in the posttest. This demonstrates a positive and meaningful shift in their mental health status.

McNemar test value was 0.001 which was significant, thus indicating that the intervention was effective.

Effectiveness of reminiscence therapy

This study looked at the mental health of the participants in the old-age home before and after receiving the reminiscence therapy. Table 3 depicts the level of improvement in mental health of the participants in the experimental group.

Factors influencing the mental health of older adults

The study showed an association for duration of stay (P value < 0.05), with the level of distress in mental health of old age home residents. There was no significant association between the other demographic variables and level of mental health.

Discussion

Globally, aging is an important issue. Worldwide, the geriatric age group is expected to rise to 1.5 billion in 2050. The healthcare of this population is of critical concern.[8]

The perception of aging is viewed differently in the developing and developed countries. In the developed countries, elderly people are being taken care of by the state providing them with care and special status. However, in developing countries, the ongoing process of globalization has caused a societal transition, leading to uncertainty among all segments of the population, especially among the elderly, about their present and future status. In India, the complex facets of aging can be viewed through a sociological lens as a progression from one set of social roles to another. These roles are defined and shaped by the social system.[9]

Erikson while describing the impact of social experience across the life span in his theory of psychosocial development, states that old age marks the process of ego integrity and despair. If the older adults have resolved the conflicts at this stage, they develop integrity and cope with their life and life events. They get adapted to the social environment, feel empowered to live, and die with dignity. When it is unresolved, they develop social isolation and feel excluded.[8] If the elderly in this era are viewed through the Erikson’s stage, the person with an unresolved conflict can feel socially isolated due to various reasons like rapidly changing circumstances in the family, emergence of nuclear family, absence of traditional support system and traditional caretakers. This creates social isolation and a feeling of exclusion, thus leaving a void in the emotional status of the elderly. This pushes them to seek the help of old age homes for shelter and to support their emotional and physical well-being.[9] This has led to the initiation of multiple old age homes forthcoming to take care of the elderly, and these homes have brought changes in the patterns of dependency among the old.

Thus, individuals who move to this stage of being sheltered in old age homes attempt to organize and interpret the changes in life by recalling the past. These changes help them to integrate into the social circumstances. This act of recollecting past events from autobiographical memory is reminiscence. Reminiscence therapy helps to improve cognitive function, develops a social connection by allowing them to share their stories, build relationships and connect to each other. This facilitates their social well-being and precludes social isolation, thereby improving quality of life.[2]

Reminiscence therapy helps in adapting to the changes that have occurred throughout their life by providing an opportunity to stimulate a positive self-attitude.[2]

Globally, many studies have been conducted to know the effectiveness of reminiscence.[4]

Very few studies have been done on assessing psychological well-being and mental health.

This study aimed at determining the effectiveness of reminiscence therapy on mental health in the inmates of old-age homes and to identify the factors influencing the (their) mental health. The factors affecting mental health and the effectiveness are discussed below.

Factors affecting the mental health of older individuals

Demographic variables like age, gender, educational status, marital status, monthly allowance, and the frequency of visits by relatives to old age homes were observed. The facts from the World Health Organization (WHO) states that quality education and a decent work with financial independence aids in promoting mental health.[10] Social isolation and loneliness are risk factors identified for developing mental health problems. The facts on mental health in older adults from WHO state that the longer the duration of time spent alone or away from loved ones, more is the deterioration in mental health.[11] The abovementioned factors are clinically significant to cause distress. However, due to the limited sample size of our study, there was no significant correlation between demographic variables and the mental health of inmates of people at the old age homes.

Effectiveness of reminiscence therapy

In a study by Chiang et al.,[12] it was found that issues like depression, self-identity, separation from loved ones, loneliness, and coping with change due to aging significantly impact the psychological well-being of institutionalized elders in eastern culture. This emphasizes the need to address these issues constructively to improve the overall well-being of elderly individuals in institutionalized settings. This was replicated as distress in the pretest of the present study.

“Reminiscence is defined as the process of thinking or telling someone about past experiences that are personally significant”.[1] Reminiscence therapy has been shown to be optimistic in improving the quality of life in these individuals.[3]

The present study used the simple, interpersonal, information type of reminiscence therapy for the participants. This group therapy has been noted to increase life satisfaction and improve well-being.[13] The investigator of the study served as a facilitator for the group by taking on a leadership role for the first one or two sessions to initiate the conversation. This involved guiding the discussion, encouraging participation, and ensuring everyone felt included. Videos, song audio files, and a variety of visual aids such as magazines and flip charts were used in the session. The group particularly enjoyed the color photos, and the visual aids served as memory triggers, prompting them to share more about their past experiences. They also enjoyed the day’s music, often joining in on the well-known tunes. Daily improvements in grooming were also observed as each member of the group realized how unique they were. As the rapport deepened with each session, the group’s interaction improved. It was observed that day by day, the memories of the group became more orderly and were expressed with more assurance and frankness. The investigator could assess the group style and group norms as the reminiscence session progressed. Among the group, the residents adopted some specific roles, such as clarifier, initiator, or monopolizer. The researcher observed that following the daily group reminiscence therapy sessions, elderly residents residing in the experimental group at the nursing home demonstrated a heightened interest in the therapy. This was evidenced by their active engagement through the sharing of personal experiences and their inquiries regarding the upcoming discussion topics for subsequent sessions. The responsiveness to each other in the group also increased, which was evident in the richness of information shared during sessions. This has been noted by Lo Gerfo et al.[13] in their study which mentions that the groups focusing on recollection have brought fellowship among them.

Reminiscence therapy created an opportunity to share emotions and experiences and a way to express their interests. The various memories recreated and shared made the participants feel engaged and provided a sense of satisfaction. The experimental group showed improvement in their behavior, communication, interest, and expression. There was a significant improvement in the level of mental health in the participants of the experimental group following the group reminiscence therapy. Out of the 26 participants who reported feeling distressed in the pretest, it was notable that 19 of them, amounting to 63.3%, displayed improved mental health in the posttest. This demonstrates a positive and meaningful shift in their mental health status.

The present study findings are comparable to the previous study by Tarugu.[14] In a study done by Ramadan Abdel-Aziz et al.[15] in the geriatric social club in Zagazig City, Egypt. In Egypt, similar observations were seen which showed group reminiscence therapy to have a significant impact on enhancing self-esteem and all emotional well-being dimensions, surpassing the effects observed in the control group. Another study by Hukkeri et al.[9] reported that reminiscence therapy is recognized for its significant potential in enhancing overall mental and emotional well-being. A systematic review and meta-analysis done by Tam et al.[4] summarized that reminiscence-based interventions are successful in boosting self-esteem and fostering psychological well-being and happiness thereby suggesting that implementing reminiscence-based interventions could serve as an effective method for enhancing the psychological well-being of healthy elderly individuals.

The improvement in their mental health evidenced could be because reminiscence therapy could have taken the role of a defense mechanism which helped in reducing dissonance and helps in ego strengthening.[12]

A recent systematic review[16] has found that reminiscence therapy is an effective intervention for improving the quality of life and life satisfaction not only for elderly with cognitive problems but also for elderly individuals with intact cognition living in the community. This intervention method significantly enhances positive psychological factors and promotes health among the elderly in the community with normal cognitive function, thereby making a substantial contribution to their healthy aging. Reminiscence therapy is not easily accessible for elderly individuals in the community. As society ages, healthcare for the elderly should prioritize prevention and community involvement. This includes actively involving elderly individuals in the community. Therefore, studies evaluating the application and effectiveness of reminiscence therapy for this population should be actively pursued.

In the future, developing and implementing a reminiscence therapy program is essential to improve the quality of life and life satisfaction of elderly individuals in the community.

The investigator faced one problem: one resident in the experimental group had a mild hearing problem. Burnside (1990) described guidelines regarding a hearing-impaired subject in the reminiscence group: not to have more than one hearing-impaired subject in the group and to seat the person next to the leader or someone in the group who is patient and will explain as needed. In addition, if the person has not understood any humor or laughter, it should be explained to him or her; otherwise, the person feels left out.[17] So, the investigator of this study made that subject sit next to her, and if she could not hear, the investigator used to explain to her again.

Reminiscence therapy speculates that remembering the past provides a meaning for creating a perspective for the present and for the future. The therapy not only helped the participants in developing a better knowledge about themselves but also helped in developing a new social relationship.[18]

Limitation

One limitation of the study is the restricted data collection period of 6 weeks. Also, most of the studies done earlier across the globe have been cross-sectional or being followed up for a limited period. Hence, the long-lasting effect of therapy also remains debatable. This warrants the need for Cluster randomized controlled studies with longer duration of follow-up.[19]

Conclusion

The present study done on inmates of the elderly care facility found that group reminiscence therapy led to a significant improvement in the mental health of people. These findings underscore the potential of group reminiscence therapy in enhancing mental health among older adults in the community. This group process is based on the idea that every elderly should be able to recognize themselves as having made a meaningful contribution at some point in their history. By acknowledging their impact on mankind, individuals can experience a heightened sense of integrity and dignity. Further research in community settings and longitudinal studies would validate and extend these results that reminiscence therapy is likely to play an increasingly important role in promoting the overall health of the elderly.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.