Journal of Psychosocial Nursing and Mental Health Services

CNE Article 

Effects of Group Reminiscence Therapy on Agitated Behavior and Quality of Life in Taiwanese Older Adults With Dementia

Fang-Yu Hsu, MS; Ya-Ping Yang, PhD; Feng-Ping Lee, PhD; Chi-Jane Wang, PhD; Jing-Jy Wang, PhD

Abstract

The purpose of the current study was to evaluate short- and long-term effects of group reminiscence on agitated symptoms and quality of life (QOL) for individuals with dementia. A quasi-experimental study using a repeated-measures design was conducted in 43 residents with dementia. Participants received a 50-minute group reminiscence therapy session once per week for 10 weeks. Outcomes were measured 1 week before, 1 week after, and at 3 months postintervention. Results showed no significant difference on the overall agitated behavior of participants. However, verbally aggressive behavior decreased significantly (p = 0.025), whereas intentional falling (p = 0.025), hoarding (p = 0.021), and akathisia (p = 0.027) significantly decreased in the short term. Participation in group reminiscence therapy significantly improved QOL (p < 0.001) across time periods for individuals with dementia. The findings provide information for professional and nonprofessional caregivers of individuals with specific agitated behaviors to improve their QOL. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 30–36.]

Abstract

The purpose of the current study was to evaluate short- and long-term effects of group reminiscence on agitated symptoms and quality of life (QOL) for individuals with dementia. A quasi-experimental study using a repeated-measures design was conducted in 43 residents with dementia. Participants received a 50-minute group reminiscence therapy session once per week for 10 weeks. Outcomes were measured 1 week before, 1 week after, and at 3 months postintervention. Results showed no significant difference on the overall agitated behavior of participants. However, verbally aggressive behavior decreased significantly (p = 0.025), whereas intentional falling (p = 0.025), hoarding (p = 0.021), and akathisia (p = 0.027) significantly decreased in the short term. Participation in group reminiscence therapy significantly improved QOL (p < 0.001) across time periods for individuals with dementia. The findings provide information for professional and nonprofessional caregivers of individuals with specific agitated behaviors to improve their QOL. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 30–36.]

Dementia is becoming increasingly prevalent as the worldwide population ages. Alzheimer's Disease International (2015a) has estimated that the number of individuals with dementia will reach 74.7 million in 2030 and 131.5 million in 2050. The increase will be considerable among developing countries. On average, a new patient is diagnosed with dementia every 3 seconds (Alzheimer's Disease International, 2015b). In Taiwan, dementia prevalence has been reported for six age groups: 3.4% for age 65 to 69; 3.5% for age 70 to 74; 7.2% for age 75 to 79; 13% for age 80 to 84; 21.9% for age 85 to 89; and 36.9% for age ≥90 (Taiwan Alzheimer Disease Association [TADA], 2015). These data reveal the impact of an aging society on the prevalence of dementia and the need for attentive care as well as the growing number of families affected by the disease (Gómez-Gallego, Gómez-Amor, & Gómez-García, 2012).

Dementia has been named a major neurocognitive disorder (NCD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2013). A diagnosis of major NCD requires evidence of significant decline from a previous level of performance in at least one of the following cognitive domains: complex attention, executive function, learning and memory, language, perceptual/motor function, and social cognition (APA, 2013). Behavioral and psychological symptoms of dementia (BPSD) are known as troublesome neuropsychiatric symptoms. More than 80% of individuals with dementia experience at least one type of BPSD (TADA, 2015). Caregivers consider BPSD difficult to manage (Shearer, Green, Ritchie, & Zajicek, 2012).

Agitation, one manifestation of BPSD, includes verbal or physical outbursts, general emotional distress, restlessness, pacing, and similar aggressive or nonaggressive forms of behaviors. The appearance and aggravation of agitation affects patients themselves and can result in mental and physical exhaustion while frustrating caregivers (TADA, 2015). Agitation also affects quality of life (QOL) and has become the primary reason for early institutionalization of individuals with dementia (Gómez-Gallego et al., 2012; Shearer et al., 2012). It is critical to provide appropriate care to reduce agitation and maintain or improve QOL for individuals with dementia (Logsdon, Gibbons, Mccurry, & Teri, 1999).

Nonpharmacological complementary therapy for individuals with dementia has been recommended prior to the use of medications to reduce use and adverse effects of drugs (Curtin, 2011). Reminiscence therapy, a nonpharmacological intervention for individuals with dementia, is described as a mental process that involves recalling the past. The theoretical foundation of reminiscence therapy was adapted from Butler's life review process and Erickson's developmental theory. Butler (1963) believes that ego integrity is attained through recalling one's past and an evaluative perspective. Butler (1963) believes reminiscence is a universal mental process brought about by the realization of approaching dissolution and death. Erickson, Erickson, and Kinvick (1986) outlined eight stages of human development spanning the life cycle from birth to death. The final stage is ego integrity versus despair. Older adults must develop ego integrity, a sense of satisfaction with life, its meaning, and a belief that life is fulfilling and successful. Reminiscence entails a progressive return to an awareness of past experiences, allowing salient life experiences to be reexamined and reintegrated. Familiar events are used for thematic guidance so that patients can recall meaningful experiences and awaken memories of the past (Haight & Burnside, 1992). Because dementia limits an individual's ability to learn new information, emotional functions are far better than cognitive functions for reminiscence therapy (TADA, 2015). Several researchers have applied reminiscence therapy for individuals with dementia (Karttunen et al., 2011; Serrani Azcurra, 2012; Wu, 2011).

The effects of reminiscence on overall BPSD, depression, anxiety, and QOL have been previously examined (Barrios et al., 2013; Graske, Fischer, Kuhlmey, & Wolf-Ostermann, 2012). However, findings on the effects of group reminiscence on the overall symptoms of agitation and QOL have been inconsistent (Baillon et al., 2004; Nawate, Kaneko, Hanaoka, & Okamura, 2008). Some studies have found that group reminiscence therapy significantly decreased overall BPSD, reduced agitation, and improved QOL of patients and caregivers (Banerjee et al., 2009; Curtin, 2011; Huang, Chiu, Wang, & Yeh, 2011; Nawate et al., 2008; Woods, Spector, Jones, Orrell, & Davies, 2005). However, Baillon et al. (2004) conducted group reminiscence therapy on patients with mild to moderate dementia and found no positive effect. Yet, it has been repeatedly established that group reminiscence therapy effectively improves QOL of individuals with dementia (Woods et al., 2005). van der Linde, Stephan, Savva, Dening, and Brayne (2012) performed a systematic literature review and found that BPSD are closely related to QOL, with improvements in QOL of individuals with dementia made through prevention, treatment, and management of BPSD (Barrios et al., 2013; Nawate et al., 2008; Serrani Azcurra, 2012; van der Linde et al., 2012; Woods et al., 2005).

Overall, agitated behaviors vary, and most studies have focused on managing agitated behaviors in individuals with dementia, with only one study applying reminiscence therapy on individual agitated behaviors (van der Linde et al., 2012). Moreover, the study of individuals with dementia among Asian populations is lacking. Thus, the current study investigated the effectiveness of group reminiscence therapy on agitated behaviors and QOL of individuals with dementia to test the following hypotheses:

  • The overall and individual agitated behaviors of individuals with dementia will decrease after receiving group reminiscence therapy and persist for 12 weeks.
  • QOL of individuals with dementia will improve after receiving group reminiscence therapy and persist for 12 weeks.

Method

Aims

The purpose of the current study was to evaluate the effects of group reminiscence therapy on agitated behaviors and QOL of individuals with dementia.

Design and Participants

A quasi-experimental study was performed using a repeated-measures design. Residents with dementia from five long-term care institutions in southern Taiwan were selected through purposive sampling. Inclusion criteria were: (a) diagnosis of any type of dementia by a physician or a Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) score of 10 to 23 for older adults who had graduated from elementary school and 10 to 18 for older adults who did not graduate from elementary school; (b) capable of speaking or understanding Mandarin or Taiwanese; (c) able to hear with or without hearing devices; and (d) at least one symptom of agitation on the Cohen-Mansfield Agitation Inventory (CMAI; Cohen-Mansfield & Billing, 1986; Cohen-Mansfield, Marx, & Rosenthal, 1989). Exclusion criteria were history of mental illness, acute illness, or contraction of an illness within the previous 1 week with ongoing weakness or inability to sit for at least 50 minutes. The sample size was estimated by G-power software. To achieve 20% effect size and 80% power for significance at alpha level 5% with a three-time repeated measures design (Cohen, 2013), at least 39 participants were needed.

Intervention

A 50-minute group reminiscence therapy session was conducted once per week for 10 consecutive weeks. Each of the five groups included 10 to 12 participants. Each week a different theme was planned: “Really nice to meet you”; “Let's talk about our childhood memories together”; “It's that flavor”; “Songs from the past”; “Celebrating the New Year”; “Your hometown and mine”; “What did I do”; “My most unforget-table event”; “The relatives I love”; and “My awards.” Each reminiscence theme was divided into four stages. The first 10 minutes was the warm-up stage, during which group members introduced themselves and reviewed the previous week's theme. The second stage was 30 minutes, during which the concepts of group dynamics and group reminiscence therapy were used to ask members to share their past experiences and current feelings regarding the week's theme. The third stage was 8 minutes, during which members shared their thoughts and suggestions regarding the week's theme. The third stage served as a reference when conducting the next group meeting. During the final 2 minutes, the activity for the following week was introduced.

Data Collection

After review and approval by the institutional review board (IRB), activity plans and themes based on participants' common life experiences, ages, and interests were determined. Five practitioners (i.e., nurse, occupational therapist, nursing professor, psychologist, and social worker), each of whom had at least 5 years of experience in dementia care, provided an expert review of the activity plans.

After receiving consent from the five participating managers or leaders of the institutions, residents were referred to the researcher (F.-Y.H.). The researcher personally explained the goals of the study to all potential participants and their families. After obtaining signed consent, pretests were administered 1 week before study onset. Posttests were administered 1 week after the end of the intervention and repeated at 12 weeks. The researcher, a psychiatric nurse with reminiscence group training, led all five groups throughout the 10 weeks. The study was conducted between July and December 2015.

Instruments

The Chinese version of the MMSE, translated by Guo et al. (1988), was used to screen all participants. The Chinese version of the CMAI for institutional use, translated by Line, Kao, Tzeng, and Lin (2007), was used to measure agitated symptoms. The 29 symptoms of agitation are divided into physically aggressive behaviors, physically nonaggressive behaviors, verbally aggressive behaviors, and verbally nonaggressive behaviors. The frequency of agitated behaviors in the previous 2 weeks is graded on a 7-point Likert scale (1 = never, 2 = less than once per week, 3 = 1 to 2 times per week, 4 = numerous times per week, 5 = 1 to 2 times per day, 6 = numerous times per day, and 7 = numerous times per hour) for a total score ranging from 29 to 203. A higher score indicates more severe agitation. The CMAI Chinese version content validity index is 0.99 and the intraclass coefficients (ICCs) are 0.69 to 0.74 (Finkel, Lyons, & Anderson, 1992). The CMAI is an observation scale. Long-term facility nurses were trained in the completion of the inventory; interrater training was performed with primary caregivers until a satisfactory reliability of 0.80 was achieved.

QOL of residents with mild to moderate dementia and MMSE scores >10 was evaluated using the Chinese version of the QOL-Alzheimer's Disease Scale (QOL-AD) translated by Fuh and Wang (2006) with a test–retest reliability (ICC) of 0.83. The scale uses a 4-point Likert scale (1 = poor to 4 = good) to assess 13 indicators: physical health, energy, mood, home environment, memory, family, marriage, friends, the patients themselves, family capabilities, recreational capabilities, finances, and overall living. Total score ranges from 13 to 52, with higher scores indicating better QOL (Chen, Wen, Wong, Tsai, & Liu, 2013). The scale was administered by the researcher.

Ethical Considerations

The study was approved by the Ethical Committee of the University IRB. Five facilities were invited to participate in the study and consent from the administrator of each facility was obtained. Participants and family surrogates of individuals with moderate and severe dementia were contacted in-person; the study's purpose and risks and benefits of participation were explained, and informed written consent was obtained. For individuals who were unable to sign the consent form, family surrogates provided assent. If participants demonstrated any physical weakness or expressed unwillingness to continue participating during the program, they were free to withdraw and were referred to caregivers.

Data Analysis

Two-tailed tests were used to analyze data using SPSS version 17, and a p value of 0.05 was considered significant. Generalized estimating equations were used to determine differences in the main variables during the study time periods.

Results

Demographic Characteristics

Of the 48 residents recruited, only 43 completed the pre- and posttest and 40 completed the follow-up test at 12 weeks for a dropout rate of 7% (Table 1).

Participant Characteristics (N = 43)

Table 1:

Participant Characteristics (N = 43)

Changes in Agitation

The CMAI total scores for agitated behavior were 38.93 (SD = 1.52) in the pretest, 38.72 (SD = 1.81) in the post-test, and 39.72 (SD = 2.27) at 12 weeks. No significant differences were found across the three measurements. Only the verbally aggressive subscales of the CMAI demonstrated significant change (p = 0.025) (Table 2).

Changes in Outcome Measures Across Time Periods (N = 43)

Table 2:

Changes in Outcome Measures Across Time Periods (N = 43)

Changes in Individual Agitated Behaviors

Analysis of each of the 29 items of the CMAI indicated that intentional falling, hoarding, and akathisia changed significantly but only for a short time. The posttest score for intentional falling was significantly lower than the pretest score (p = 0.025), but the follow-up test was significantly higher (p = 0.025), indicating that group reminiscence therapy had a short-term effect on intentional falling. The posttest score for hoarding was significantly lower than the pretest score (p = 0.021), but remained unchanged at 12 weeks, also indicating a short-term effect. Similarly, the posttest score for akathisia was significantly lower than the pretest score (p = 0.008) but returned to baseline at 12 weeks.

Changes in Quality of Life

QOL on the pre-, post-, and follow-up test was 26.68 (SD = 0.68), 29.44 (SD = 0.86), and 32.12 (SD = 1.02), respectively. The posttest score was higher than the pretest score (p = 0.007); the follow-up test score was higher than the posttest score (p = 0.007) (Table 2). Thus, group reminiscence therapy had a significant long-term, positive, and sustained effect on QOL.

Figure 1 demonstrates the changes in all outcome measures over the study period.

Changes in outcome measures across time periods (N = 43).Note. QOL = quality of life; CMAI = Cohen-Mansfield Agitation Inventory; PNA = physically nonaggressive; PA = physically aggressive; VNA = verbally nonaggressive; VA = verbally aggressive.

Figure 1.

Changes in outcome measures across time periods (N = 43).

Note. QOL = quality of life; CMAI = Cohen-Mansfield Agitation Inventory; PNA = physically nonaggressive; PA = physically aggressive; VNA = verbally nonaggressive; VA = verbally aggressive.

Discussion

Effects of Group Reminiscence Therapy on Agitation

In the current study, symptoms of agitation did not improve significantly after 10 weeks of group reminiscence therapy in individuals with dementia. Dementia is a progressive degenerative disease; thus, as the disease advances, patients continue to experience degeneration in cognition and physical and verbal behaviors. In addition, symptoms of agitation are unique and differ among individuals with dementia. Reminiscence is pleasant and distracting, and it appears to impact agitated behaviors (Chen et al., 2013; Fuh & Wang, 2006; Thorgrimsen et al., 2003). The short-term effect of reminiscence therapy on three individual behaviors—intentional falling, hoarding, and akathisia—may indicate that individuals with dementia become immersed in the reminiscence atmosphere, which diverts their attention (Chen et al., 2013; Fuh & Wang, 2006; Thorgrimsen et al., 2003). The current results are similar to a previous study, which suggested that individuals with dementia could immerse themselves in nostalgia and feelings of joy by participating in activities that distract them from performing agitated behaviors (Graske et al., 2012). By having their attention diverted with reminiscence, individuals with dementia may disregard the involuntary impulse to get up, move, and engage in agitated and disorderly behaviors.

In addition, individuals with dementia who participated in reminiscence therapy did not experience a worsening of agitation from the environmental stimuli. This finding is consistent with the concept that “not deteriorating is a good sign” (Chen et al., 2013, p. 90). Thus, the continued use of reminiscence therapy for individuals with dementia may be more beneficial to slow progression of the disease. No previous studies have analyzed the effects of reminiscence therapy on individual agitation behaviors, such as intentional falling, hoarding, and akathisia; thus, the findings of positive effects of reminiscence therapy on these agitated behaviors may be important references for caregivers who manage the behaviors of individuals with dementia.

Effects of Group Reminiscence Therapy on Quality of Life

The results of the current study indicate that group reminiscence therapy improved QOL of individuals with dementia, with effects lasting for 3 months. Reminiscence therapy primarily enhances emotional functions while promoting social interaction and interpersonal relationships among group members. The inner satisfaction and joy while providing a sense of psychological and emotional comfort may have enhanced QOL. Previous studies have also found that participating in reminiscence activities and recalling the past can evoke deep memories in individuals with dementia, eliciting inner satisfaction and an improved sense of life (León-Salas et al., 2013; Serrani Azcurra, 2012). In addition, reminiscence in groups can also achieve a group therapy effect, as noted by Yalom (1995). Mutual support and sharing of life experiences among group members leads to increased interpersonal interactions and promotes psychological adjustment. As members participate in more group reminiscence activities, their participation, identity, and self-disclosures during these activities can also improve. A greater sense of spiritual comfort, satisfaction, and pleasure can promote an improvement in QOL (Chen et al., 2013). However, previous studies have failed to investigate the long-term effects of group reminiscence therapy on QOL of individuals with dementia; therefore, further research is needed.

Limitations and Future Research

First, although small, the sample size was sufficient for meaningful statistical analysis. Future studies should consider a larger sample for greater explanatory power. Second, the study could have been designed better with more frequent reminiscence groups and outcome measures. The lack of a control group infers that only limited inferences can be made from the data. No effort was made to determine the influence of the natural deterioration or illness process of residents during the course of this study. Future studies should compare group reminiscence therapy with other complementary therapies, such as cognitive stimulation, aromatherapy, multisensory therapy, and music therapy. In addition, the degree of participation must be considered when analyzing data in future studies.

Conclusion

Group reminiscence therapy has no significant effect on overall agitated behavior, but significant effects on individual dementia behaviors of intentional falling, hoarding, and akathisia were found. QOL was improved with group reminiscence therapy. Patients with dementia are unique and present with diverse BPSD; not all problematic behaviors are amenable to treatment (Chen, Wen, Wong, Tsai, & Liu, 2013). Although BPSD did not significantly diminish, group reminiscence therapy did not result in further deterioration and may have prevented worsening of symptoms. Dementia-agitated behaviors are treated differently, where appropriate interventions must be provided based on each patient's need for effective and comprehensive care. Findings of the current study provide information for professional and nonprofessional caregivers to improve QOL of individuals with dementia with specific agitated behaviors.

References

  • Alzheimer's Disease International. (2015a). Dementia statistics. Retrieved from https://www.alz.co.uk/research/statistics
  • Alzheimer's Disease International. (2015b). World Alzheimer report 2015: The global impact of dementia. Retrieved from https://www.alz.co.uk/research/world-report-2015
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  • Baillon, S., Van Diepen, E., Prettyman, R., Redman, J., Rooke, N. & Campbell, R.A. (2004). Comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia. International Journal of Geriatric Psychiatry, 19, 1047–1052. doi:10.1002/gps.1208 [CrossRef]
  • Banerjee, S., Samsi, K., Petrie, C.D., Alvir, J., Treglia, M., Schwam, E.M. & del Valle, M. (2009). What do we know about quality of life in dementia: A review of the emerging evidence on the predictive and explanatory value of disease specific measures of health-related quality of life in people with dementia. International Journal of Geriatric Psychiatry, 24, 15–24. doi:10.1002/gps.2090 [CrossRef]
  • Barrios, H., Narciso, S., Guerreiro, M., Maroco, J., Logsdon, R. & de Mendonca, A. (2013). Quality of life in patients with mild cognitive impairment. Aging & Mental Health, 17, 287–292. doi:10.1080/13607863.2012.747083 [CrossRef]
  • Butler, R.N. (1963). The life review: An interpretation of reminiscence in the aged. Psychiatry, 26, 65–76. doi:10.1080/00332747.1963.11023339 [CrossRef]
  • Chen, L.J., Wen, S.H., Wong, Y.J., Tsai, L.J. & Liu, J.R. (2013). A study on the effect of structured group activities on dementia care [article in Chinese]. Taiwan Social Work, 12, 65, 67–99.
  • Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York, NY: Routledge Academic. doi:10.4324/9780203771587 [CrossRef]
  • Cohen-Mansfield, J. & Billing, N. (1986). Agitated behaviors in the elderly: A conceptual review. Journal of the American Geriatrics Society, 34, 711–721. doi:10.1111/j.1532-5415.1986.tb04302.x [CrossRef]
  • Cohen-Mansfield, J., Marx, M.S. & Rosenthal, A.S. (1989). A description of agitation in a nursing home. Journal of Gerontology, 44(3), M77–M84. doi:10.1093/geronj/44.3.M77 [CrossRef]
  • Curtin, A.J. (2011). Individualized skills training program for community-dwelling adults with mild Alzheimer's disease. Journal of Gerontological Nursing, 37(10), 20–29. doi:10.3928/00989134-20110914-50 [CrossRef]
  • Erickson, E.H., Erickson, J.M. & Kinvick, H.Q. (1986). Vital involvement in older age: The experience of old age in our time. New York, NY: Norton.
  • Finkel, S.I., Lyons, J.S. & Anderson, R.L. (1992). Reliability and validity of the Cohen-Mansfield agitation inventory in institutionalized elderly. International Journal of Geriatric Psychiatry, 7, 487–490. doi:10.1002/gps.930070706 [CrossRef]
  • Folstein, M.F., Folstein, S.E. & McHugh, P.R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6 [CrossRef]
  • Fuh, J.L. & Wang, S.J. (2006). Assessing quality of life in Taiwanese patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 103–107. doi:10.1002/gps.1425 [CrossRef]
  • Gómez-Gallego, M., Gómez-Amor, J. & Gómez-García, J. (2012). Determinants of quality of life in Alzheimer's disease: Perspective of patients, informal caregivers, and professional caregivers. International Psychogeriatrics, 24, 1805–1815. doi:10.1017/S1041610212001081 [CrossRef]
  • Graske, J., Fischer, T., Kuhlmey, A. & Wolf-Ostermann, K. (2012). Quality of life in dementia care: Differences in quality of life measurements performed by residents with dementia and by nursing staff. Aging & Mental Health, 16, 819–827. doi:10.1080/13607863.2012.667782 [CrossRef]
  • Guo, N.W., Yin, J.C., Liu, H.C., Wang, P.F., Liao, K.K. & Yan, S.H. (1988). Chinese version and norms of the Mini-Mental State Examination [article in Chinese]. Journal of Chinese Rehabilitative Medicine, 16(6), 52–59.
  • Haight, B.K. & Burnside, I. (1992). Reminiscence and life review: Conducting the processes. Journal of Gerontological Nursing, 18(2), 39–42.
  • Huang, H.L., Chiu, Y.L., Wang, L.C. & Yeh, M.C. (2011). Issues related to quality of life measures for persons with dementia [article in Chinese]. Hu Li Za Zhi, 58(2), 63–67.
  • Karttunen, K., Karppi, P., Hiltunen, A., Vanhanen, M., Valimaki, T., Martikainen, J. & Pirttila, T. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473–482. doi:10.1002/gps.2550 [CrossRef]
  • León-Salas, B., Olazarán, J., Cruz-Orduña, I., Agüera-Ortiz, L., Dobato, J.L. & Valentí-Soler, I.L. (2013). Quality of life (QOL) in community-dwelling and institutionalized Alzheimer's disease (AD) patients. Archives of Gerontology and Geriatrics, 57, 257–262. doi:10.1016/j.archger.2013.04.013 [CrossRef]
  • Line, L.C., Kao, C.C., Tzeng, Y.L. & Lin, Y.J. (2007). Equivalence of Chinese version of the Cohen-Mansfield agitation inventory. Journal of Advanced Nursing, 59, 178–185. doi:10.1111/j.1365-2648.2007.04303.x [CrossRef]
  • Logsdon, R.G., Gibbons, L.E., Mccurry, S.M. & Teri, L. (1999). Quality of life in Alzheimer's disease: Patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.
  • Nawate, Y., Kaneko, F., Hanaoka, H. & Okamura, H. (2008). Efficacy of group reminiscence therapy for elderly dementia patients residing at home: A preliminary report. Physical & Occupational Therapy in Geriatrics, 26(3), 57–68. doi:10.1080/J148v26n03_04 [CrossRef]
  • Serrani Azcurra, D. (2012). A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease: A randomized controlled trial. Revista Brasileira de Psiquiatria, 34, 422–433. doi:10.1016/j.rbp.2012.05.008 [CrossRef]
  • Shearer, J., Green, C., Ritchie, C.W. & Zajicek, J.P. (2012). Health state values for use in the economic evaluation of treatments for Alzheimer's disease. Drugs & Aging, 29, 31–43. doi:10.2165/11597380-000000000-00000 [CrossRef]
  • Taiwan Alzheimer Disease Association. (2015). Global dementia report from the World Health Organization [website in Chinese]. Retrieved from http://www.tada2002.org.tw/About/IsntDementia
  • Thorgrimsen, L., Selwood, A., Spector, A., Royan, L., De-Madariaga, L.M. & Woods, R.T. (2003). Whose quality of life is it anyway? The validity and reliability of the Quality of Life-Alzheimer's Disease (QoL-AD) scale. Alzheimer Disease and Associated Disorders, 17, 201–208. doi:10.1097/00002093-200310000-00002 [CrossRef]
  • van der Linde, R.M., Stephan, B.C., Savva, G.M., Dening, T. & Brayne, C. (2012). Systematic reviews on behavioural and psychological symptoms in the older or demented population. Alzheimer's Research and Therapy, 4, 28. doi:10.1186/alzrt131 [CrossRef]
  • Woods, B., Spector, A.E., Jones, C.A., Orrell, M. & Davies, S.P. (2005). Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews, 18(2), CD001120. doi:10.1002/14651858.CD001120.pub2 [CrossRef]
  • Wu, L.F. (2011). Group integrative reminiscence therapy on self-esteem, life satisfaction and depressive symptoms in institutionalised older veterans. Journal of Clinical Nursing, 15, 2195–2203. doi:10.1111/j.1365-2702.2011.03699.x [CrossRef]
  • Yalom, I.D. (1995). The theory and practice of group psychotherapy (4th ed.). New York, NY: Basic Books.

Participant Characteristics (N = 43)

VariableMean (SD) (Range)
Age (years)78.65 (6.7) (62 to 91)
Years of education4.42 (4.51) (0 to 12)
Number of chronic diseases2.67 (1.46) (0 to 6)
MMSE scorea13.51 (3.12) (10 to 22)
CMAI scoreb38.93 (10.05) (30 to 79)
QOL-AD scorec26.67 (4.49) (18 to 38)
n (%)
Gender
  Female29 (67.4)
  Male14 (32.6)
Marital status
  Widowed25 (58.1)
  Married9 (20.9)
  Single/separated/divorced9 (20.9)
Religious belief
  Traditional believerd16 (37.2)
  Buddhist16 (37.2)
  Christian/Catholic6 (14)
  None5 (11.6)
Sessions attended/participated
  <73 (7)
  71 (2.3)
  89 (20.9)
  98 (18.6)
  1022 (51.2)

Changes in Outcome Measures Across Time Periods (N = 43)

VariablePretestPosttest12-Week Follow UpZp Value
Quality of life26.68 (0.68)29.44 (0.86)32.12 (1.02)30.414<0.001
CMAIa
  Overall38.93 (1.52)38.72 (1.81)39.72 (2.27)0.660.720
  Physically nonaggressive13.30 (0.69)13.26 (0.73)13.14 (0.93)0.0720.965
  Physically aggressive13.95 (0.33)14.21 (0.56)14.88 (0.75)2.3190.314
  Verbally nonaggressive8.28 (0.55)8.33 (0.54)8.86 (0.74)1.0720.585
  Verbally aggressive3.49 (0.33)2.79 (0.24)3.12 (0.27)7.4150.025
Authors

Ms. Hsu is Lecturer, Department of Nursing, Yuh-Ing Junior College of Health Care and Management, Kaoshiung, Taiwan; Dr. Yang is Assistant Professor, College of Nursing, Kaoshiung Medical University, Kaoshiung, Taiwan; Dr. Lee is Case Manager, Pro Health Home Health Services, Davis, California; and Dr. C.-J. Wang is Associate Professor, and Dr. J.-J. Wang is Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Financial support for this study was obtained from the Ministry of Science Technology of Taiwan (102-2314-B-006-062-MY2).

Address correspondence to Jing-Jy Wang, PhD, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan City 70101, Taiwan, ROC; e-mail: ns127@mail.ncku.edu.tw.

Received: August 07, 2018
Accepted: January 25, 2019
Posted Online: April 11, 2019

10.3928/02793695-20190315-01

Sign up to receive

Journal E-contents