Nursing uses reminiscence as an intervention for meeting the diverse needs of the elderly population. It has been used to reduce loneliness, improve selfesteem, accept approaching death, improve mood, increase cognitive functioning, and increase life satisfaction.1"7 This article will review the research that has been done on reminiscence.
Most authors have conceptualized and operationalized reminiscence in global terms, even though there is evidence to suggest that various categories of reminiscence do exist. McMahon and Rhudick have defined reminiscing as "the act or habit of thinking about or relating past experiences, especially those considered personally most significant."8 Reminiscence has been measured through the use of questionnaires or content analysis of transcribed reminiscences.9,10 The validity and reliability of these instruments has, in most instances, been untested or poor.
THEORY RELATED TO REMINISCENCE
Little attention has been paid to linking reminiscence research to theory. Only one theory, Butler's theory of life review, has been tested by reminiscence research studies.11 Butler used Erikson's developmental theory to propose a process during old age called the life review.12 Erikson uses specific dichotomies to characterize the critical issues of each phase of human development. During old age, the precipitated crisis is called ego integrity versus despair. During this time, elderly people evaluate their past experiences and accomplishments in terms of whether they have attained their major life goals. Depending on whether the person is able to find order and meaning in life, this reviewing of the past will result in either the attainment of ego integrity or despair.
Butler believes that ego integrity is attained through recalling one's past from an analytical and evaluative perspective. This process is called the life review, and Butler believes it is a universal mental process brought about by the realization of approaching dissolution and death. Life review serves a psychotherapeutic function in which older persons reflect on their pasts to resolve, reintegrate, or reorganize what is troubling or preoccupying them. Although the terms "life review" and "reminiscence" are often used interchangeably in the literature, research suggests there may be several categories of reminiscence, and delineation of the attributes and boundaries of these concepts is needed.
Researchers who have studied reminiscence have not built their research on previous empirical studies. This has led to reminiscence research that does not readily form a coherent body of knowledge. Studies vary considerably in degree of methodological sophistication. Only two research studies have examined categories of reminiscence; all others have conceptualized and operationalized reminiscence globally.
Gorney found that subjects in their 60s and 70s engaged in life review reminiscence whereas subjects in their 80s and 90s displayed life review resolution.13 Coleman found that subjects who were dissatisfied with their past lives engaged in life review more than those who were satisfied with their past.9 This group of individuals who indicated both some degree of dissatisfaction with their past but did not review their lives to any marked degree showed signs of maladjustment. Brennan and Steinberg also found that satisfaction with the past was significantly and negatively correlated with quantity of reminiscence.14 Other researchers, however, have found that elderly people who are satisfied with their past reminisce most frequently and that the content of these reminiscences is of pleasant past experiences. 10,15
Hyland and Ackerman found the vast majority of subjects in their study rated their reminiscence activity as pleasant.16 There was, however, a significant relationship (r=.32, P<.05) between frequency of reminiscence and negative affect. The authors speculated that this finding may reflect a problem solving function of reminiscence. There is no evidence to suggest that awareness of one's mortality is associated with increased reminiscence.17
Boylin et al attempted to test the relationship of reminiscing to Erikson's stage of integrity versus despair.18 According to Erikson's theory, it would be expected that elderly persons who reminisce would be characterized as having ego integrity, whereas those who do not reminisce would have a greater degree of despair. There was a significant correlation (r=.41, P<.005) between frequency of reminiscing and scores on the ego integrity subscale. Ego integrity was correlated with negative affects of reminiscing (r=.45, /><.005). This finding failed to support their hypothesis that elderly persons who have achieved ego integrity would have a favorable attitude toward their past experiences.
Havighurst and Glasser, in a correlational study, found that positive affect of reminiscence was significantly correlated with positive self-concept.10 Several experiments have examined the relationship of reminiscence to self-concept and self-esteem. Lewis found that reminiscers, when faced with an experimental social threat, displayed a significant increase in the correlation between their past and present self-concepts when compared with non-reminiscers.17 Ingersoll and SiIverman19 and Lappe20 both used a pretest/post-test control group design and found that reminiscence therapy groups displayed significantly greater improvements in self-esteem than the comparison groups. Perrotta and Meacham, however, used the same design and found no significant change in self-esteem from pretest to post-test, and no significant difference between treatment and control group selfesteem scores.21
Sherman compared a reminiscence group that used conventional techniques for recalling memories with an experiential technique that included focusing on feelings and thoughts.22 These groups were compared with each other and with control samples. All groups increased in satisfaction and self-concept, but there was not a statistically significant difference between experimental and control groups. The experimental groups did display more inclusive and less avoidant types of reminiscing (/><.001), and the group that used experiential reminiscing techniques incorporated the greatest measure of feelings and thoughts in their reconstruction of the past (/><.05).
Touch and reminiscing were used in group therapy by Moore with 40 elderly women residing in two extended care facilities.23 There was a significant difference (P<.05) in self-esteem from pretest to post-test for subjects who received a combination of touch and reminiscence therapy. Those subjects who received reminiscence or touch alone did not show a significant difference from pretesting to posttesting.
Several empirical studies have supported the idea that reminiscing about positive past experiences may serve to maintain positive mood states or improve mood.4,10,15,19,24,25 These findings are contradictory to Butler's belief that life review reminiscence is done to rework troubling memories so that one can achieve an integrated and positive conception of self.
The findings of Oliveria are inconsistent with the life review process in several aspects.15
* Reminiscence was used to help relive pleasant experiences by 48% of the sample; in life review, reminiscing is concerned with reworking troubling memories.
* Reminiscing was accompanied by a good feeling for 77% of the subjects; in life review, reminiscence can be accompanied by a good feeling but is characterized as being accompanied by guilt, anxiety, conflict, and depression.
* Ninety percent of high reminiscers indicated satisfaction with their past; in life review, increased reminiscence is associated with dissatisfaction with the past as one attempts to resolve the source of this dissatisfaction.
* Most of the reminiscences were about pleasant experiences from the past; during life review, the focus of the reminiscence is on past experiences with which one is dissatisfied, and with which the person needs to "come to terms."
* This sample reminisced more about childhood and adolescence and indicated that these periods were the least dreary for them; during life review, the focus is on experiences in the past that are troubling to the person.
Revere and Tobin hypothesized that the elderly would not only be more involved in their past than middle-aged persons, but would also mythicize their past as reflected in ratings of dramatization, involvement, and reconciliation.26 Comparisons between a middle-aged and elderly sample revealed significantly greater involvement and dramatization in the elderly group, but no differences in reconciliation. The significant difference found between the two groups on involvement suggests that older persons are more involved in their past than middle-aged persons. Significant differences on the dramatization scale suggest that older people mythicize their reminiscences to a greater extent than younger people. Older people may no longer need to see the past realistically; instead the need may be to see the past in a way that will be perceived as achieving some measure of immortality or to see oneself as a hero of a drama worth having lived for.
This data suggests there may be a change in the modal style of reminiscing for different age groups, and that mythicizing may be one form of reminiscing in the aged. This view is contradictory to Erikson and Butler's belief that older people make sense of their lives in a way that involves acceptance of their past as it was. Reconciliation, the measure of Butler's contention that reminiscing involves accepting the negative and positive of one's past life, did not reveal significant differences between the age groups.
Haight examined the benefit of a structured reminiscence intervention for 60 homebound elderly subjects.4 There was a significant difference between control and experimental groups on life satisfaction (P=. 001) and affect (/>=.003). There was no significant difference between the two groups on depression or activities of daily living. Goldwasser et al used a reminiscence group therapy intervention with 27 demented nursing home residents and found a significant difference between the experimental and control groups on self-reported level of depression (/><.05), but no significant effects were found for cognitive or behavioral functioning.27
The number of contradictions these studies have with the life review process suggest that something other than a psychoanalytical evaluative process occurs in the reminiscences of the elderly. The samples in the four studies discussed gave no indication that they were in a process of life review. Yet, reminiscence was still actively done and may serve a function that has not yet been delineated. These studies suggest that there are one or more forms of reminiscence other than the life review, at least one of which involves recollection of pleasant experiences from the past. This type of reminiscence may be stimulated by satisfaction rather than dissatisfaction with the past, and may be viewed by the reminiscer as an enjoyable activity.
Berghorn and Schafer studied 185 nursing home residents to determine which participants in a reminiscence discussion group would be most likely to change their behaviors, mental functioning, or attitudes as a result of the reminiscence intervention.28 Demographic factors or conditions in the home did not relate to change over the intervention period. However, a statistically significant relationship was found between "mental adaptability" and change over the intervention period on behavior patterns, mental functioning, and attitudes. These findings may indicate that individuals who are not adaptive and who hold to values not supported by the social structure of the nursing home are most likely to be positively influenced by a reminiscence group intervention.
SUMMARY OF FINDINGS
Findings provide weak support for the occurrence of a life review process in some elderly,9,13,18 and the universal occurrence of a life review process has not been studied. Whether life review is elicited by dissatisfaction or satisfaction with the past has been studied with conflicting results,10,13 i5 and there is no evidence to suggest that awareness of one's mortality is associated with increased reminiscence.29 Cross-sectional designs have seriously hampered developmental conclusions that can be drawn from these studies. Also, in most studies, it is unclear if life review or another form of reminiscence is being measured since conceptual and operational clarity are absent. There is evidence that some people use reminiscence as a means for evaluating and analyzing their lives.13-15
Findings also suggest that there are one or more other forms of reminiscence than the life review. At least one of these forms involves recollections of positive experiences from the past and is associated with positive selfesteem.4-10'15,17,19,20,22-27 The general notion is that reminiscing contributes to the generation of self-referent knowledge and thereby assists the person in maintaining feelings of selfworth. Other forms of reminiscence have been postulated in published articles but have not been systematically studied.
Several empirical studies have linked reminiscence to mood.4,10,14* 16.18,24,25.27 gom me affect expressed in the reminiscence itself and a general mood score associated with reminiscing have been studied. There is evidence to support the hypothesis that reminiscing can have a beneficial effect on mood either by decreasing negative moods or increasing positive mood states.
Several experiments have studied the therapeutic benefits of reminiscence as an intervention with the elderly. Although there is little support for reminiscence influencing depression,4'21·27 there is evidence that reminiscence may help elderly people maintain or improve their mood, selfesteem, life satisfaction, or cognitive functioning.4,7,17,19,20,22,23,25
few studies have used a theoretical framework. The psychoanalytical frameworks of Butler and Erikson have been used in several studies, but there is weak empirical support for them. There is, however, a substantial amount of evidence that is contradictory to10,15,26 or inconsistent with8,17,19,20,24,25 the life review process. These studies suggest that reminiscence is a source of self-referent knowledge associated with satisfaction with one's past, positive affect of reminiscences, positive mood, present life satisfaction, and positive self-esteem. Although none of mese studies presented theoretical frameworks, theories of selfconcept could explain some of these results.
Overall, the studies reviewed for this article were methodologically weak. Differences among the studies are abundant and limit the ability to make direct comparisons of results. Reminiscence has never been clearly defined and the important variables within reminiscences have not been delineated. Measurement tools are inadequate in their validity or reliability. Samples have varied widely in characteristics such as age, sex, health, and place of residence. Sample sizes have generally been small. Perroía and Meacham21 and Ingersoll and Silverman19 included depressed subjects in their studies. Two studies used only men who resided in Veterans Administration hospitals,8,18 and many studies involved subjects who resided in longterm care facilities. Studying healthier, more representative groups would provide a more valid picture of this age group.
Various designs were used in these studies: exploratory, correlational, and experiments with random assignment. The quality of the research designs used is not as much an issue as is the quality of the research questions studied. This body of research literature has asked primarily vague, superficial questions about reminiscence. There has been a lack of effort to conceptually or operationally define the constructs of interest. Crucial information that is needed includes important variables within reminiscing; cognitive processes that occur when a person reminisces; whether reminiscing is a developmental phenomenon; and what groups of people reminisce differently than others and why.
Directions for Future Research
Evidence suggests that reminiscence takes on various forms with various functions, eliciting stimuli and affect associated with them. If these various forms do exist, studies that have examined global reminiscence are of limited usefulness because it would be impossible to determine which categories of reminiscence were associated with any observed relationships. Studies of global reminiscence have led to inconsistent and contradictory findings that further support the notion that more precision is needed in defining reminiscence. The concepts of life review and reminiscence must be differentiated.
Currently, the term life review is associated with psychoanalytic roots and the reworking of troubling memories. The term reminiscence has been used in several ways in the literature, but it is generally regarded as a more psychosocial than psychoanalytical process.
Once the phenomenon of reminiscence is more clearly defined, valid and reliable measures need to be developed. Content analysis seems superior to questionnaires for obtaining valid reminiscence data. Questionnaires are artificial and rely heavily on the subjects' ability to remember past thoughts and conversations and to categorize these according to a past, present, or future orientation.
It has been suggested that the activity of reminiscing follows a developmental pattern. Questions that need further research are: Do different age groups reminisce with differing frequencies? Do patterns or styles of reminiscing follow an age-related course? Does reminiscing serve different purposes in different age groups?
Research efforts also need to focus on linking reminiscence with other concepts, such as stress and adaptation, health and preventive care, and situationally derived needs. These links should be studied within a framework of theory building or theory testing. A developmental theory of selfconcept that captures the functions of life review and other forms of reminiscence may assist researchers in developing a useful body of knowledge on the process and functions of remembering past events.
Nursing must examine under what conditions reminiscence is a constructive or destructive cognitive occurrence and determine if a nurse can guide an individual or group in the constructive use of reminiscence. Nursing should also conduct research aimed at predicting specific nursing interventions that will lead to optimum use of reminiscence; what situational needs or preventive goals can be aided through the use of reminiscence; and, under a specific set of circumstances using reminiscence, what specific outcomes can be expected.
There is a need for nursing to develop interventions to help maintain quality of life for the growing older adult population. This article has reviewed the research done on reminiscence and the elderly. There is some evidence to suggest reminiscing may be helpful in maintaining or improving mood, cognitive functioning, life satisfaction, and self-esteem in the elderly. Several flaws in the research have been presented along with possible explanations for the contradictory and inconsistent empirical evidence regarding reminiscence. It is hoped that nurse scientists will develop a more refined conceptualization and measurement of reminiscence, and then forge ahead using rigorous research designs to develop a body of knowledge regarding reminiscence.
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