Reminiscence Therapy in Individuals With Dementia

Study Overview
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Brief Summary
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Dementia; It is a disease that requires intensive use of health services, has a high care burden, and has medical, social, psychological and economic burdens for the patient, family and society. Dementia is characterized by many disorders in cognitive functions, especially memory, thought and social skills. Progressive disorders in cognitive functions cause behavioral changes, decrease in activities of daily living, and neuropsychiatric symptoms such as anxiety and depression. evaluation and management of cognitive problems in individuals with dementia are important because they increase both the burden of care and mortality and morbidity. Various pharmacological and non-pharmacological treatments are used in the management of incurable dementia, and the treatments are mostly aimed at reducing the behavioral and psychological symptoms of the disease. The interest in non-pharmacological treatments has increased due to the moderate effectiveness of pharmacological treatments in the management of dementia, their high level of side effects and limited applicability. One of the popular non-pharmacological treatments used to enhance memory in dementia is reminiscence therapy. In reminiscence therapy, elderly individuals are provided to recall their past experiences, these experiences are talked about, and positive emotions are shared individually or in a group. It is seen that the use of reminiscence therapy, which is an important non-pharmacological treatment that is used quite frequently in the management of dementia in the world, is not at the desired level in our country, and the studies conducted are mostly interview-based. This research will be carried out with the aim of determining the effect of reminiscence therapy applied to individuals with dementia on cognitive functions, anxiety, depression and activities of daily living. In this study, reminiscence therapy will not be based only on interviews, but a separate activity program that will trigger specific recall/memory for each interview will be included, taking into account the socio-cultural structure in the therapy process. The research will be carried out in a pre-test post-test single-group, quasi-experimental research design in Amasya Suluova Hacı Muammer Koca Nursing Home Elderly Care and Rehabilitation Center. The sample of the study will consist of 28 individuals aged 65 and over with a diagnosis of dementia (mild/moderate). In this research, reminiscence therapies will be performed once a week for 8 weeks, in sessions of approximately 45 minutes. The weekly sessions to be held during the therapy process will be based on the experiences of the individuals in their life cycles, and the interviews will be conducted in the light of weekly determined topics (childhood, family life, work life, favorite meals, herbs, celebrations, the happiest moment). According to the content of the activities and goals defined for each session, memory triggering materials such as pictures, photographs, household items, old-time music, videos will be used Research data will be collected between January 2024 and Marc 2024 using the Standardized Mini Mental Test, Geriatric Anxiety Scale, Geriatric Depression Scale and Katz's Activities of Daily Living Index. Data collection forms will be applied twice in total, at the end of the 1st session (pre-test) and at the end of the 8th session (post-test). The data obtained from the research will be analyzed in the Statistical Package for Social Science (SPSS) 21 statistical program. Variables covering the descriptive characteristics of individuals with dementia will be expressed as numbers and percentages. Whether the data show normal distribution or not will be determined by Kolmogrov Smirnov test and parametric and/or nonparametric tests will be used according to the results obtained. Statistical significance value p<.05 will be accepted.

Detailed Description
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The rate of elderly population in the world is increasing day by day. According to 2019 data, the number of individuals aged 60 and over in the world is approximately 1 billion, and it is estimated that this number will increase to 1.4 billion in 2030 and 2.1 billion in 2050 (World Health Organization, 2020). The increase in the elderly population rate in Turkey is also striking. It is predicted that the population rate of 65 years and over in our country will be 9.7% (8 million 245 thousand 124 individuals) in 2021, and this rate will be 12.9% in 2030, 22.6% in 2060 and 25.6% in 2080. The current increase in the elderly population also increases the interest in the physical, psychological and social needs of older individuals (Turkish Statistical Institute, 2022). Elderly individuals face physical and mental health problems specific to their life stage. It is stated that more than 20% of individuals aged 60 and over have a mental or neurological disorder and 6.6% of all disabilities in these individuals are related to these disorders. The most common mental and neurological disorders in this age group are dementia and depression, affecting approximately 5% and 7% of the world's elderly population, respectively (World Health Organization, 2017). According to World Health Organization data, the number of individuals with dementia in 2021 is 55 million, and it is estimated that this number will reach 78 million in 2030 and 152 million in 2050 (World Health Organization, 2023). The prevalence of dementia in Turkey is stated to be 3.2% in the population aged 60 and over (Lök et al., 2017), and it is predicted that the prevalence of dementia in Turkey, which is an aging country, will increase in parallel with the elderly population (Turkish Statistical Institute, 2022). Dementia; It is a disease that requires intensive use of healthcare services, has a high care burden, and has medical, social, psychological and economic burdens for the patient, family and society. In addition, dementia is the seventh leading cause of death and one of the most important causes of disability and addiction among the elderly in the world (World Health Organization, 2023). The global cost of dementia, which poses a serious burden on the global economy, is estimated to be 1.3 trillion dollars in 2019 (World Health Organization, 2023), and it is stated that the global cost of dementia care will reach 1.6 trillion dollars by 2050 and the total expenditure may reach up to 2.4 trillion dollars (Velandia et al. ., 2022). Approximately 50% of these costs are attributed to care provided by informal caregivers (family members, close friends, etc.) who provide an average of 5 hours of care and supervision per day. Increasing care costs pose a secondary burden to countries' economies after health expenditures (World Health Organization, 2023). Dementia, a progressive neurodegenerative disease, is characterized by many disorders in cognitive functions, especially memory, thinking and social skills. These disorders, which usually manifest with amnesia, also affect other cortical functions such as speech, thought, and orientation over time. Progressive disorders in cognitive functions cause behavioral changes and decrease in daily living activities, making individuals addicted over time. Evaluation and management of cognitive problems in individuals with dementia are important because they increase both the burden of care and mortality and morbidity (Amin et al., 2019; Cloak et al., 2019). Dementia is a disease that causes not only cognitive decline but also a variety of behavioral and psychiatric symptoms. Behavioral and psychiatric symptoms that develop due to dementia affect approximately 90% of individuals with dementia and cause a wide range of neuropsychiatric symptoms, including impaired thought content, low mood and personality traits. The most common of these neuropsychiatric symptoms is depression. Depression is a social and functional disorder manifested by depressed mood, lack of energy, reluctance to participate in social activities, sleep and appetite problems, and suicidal thoughts. Depression, which is an important cause of social, physical and behavioral problems, accelerates the prognosis of dementia and causes a decrease in the quality of life. Considering the effects of depression on disability, physical and cognitive losses, and quality of life, the importance of evaluating and managing depression in individuals with dementia emerges (Masters et al., 2015; Walaszek, 2020). Another common problem in individuals with dementia is anxiety. It is stated that anxiety, similar to depression, increases the severity of neurological disorders in individuals with dementia, which negatively affects independence, caregiver burden and the risk of need for long-term care. For this reason, it is emphasized that the management of anxiety symptoms is an important part of dementia treatment (Orgeta et al., 2022; Tonga et al., 2020). In addition, physical, social and psychological problems, especially cognitive, experienced in dementia negatively affect all life activities of individuals (Alzheimer's Association Report, 2022). Effective management of the disease is very important in reducing the problems experienced by individuals with dementia, continuing their life activities and increasing their independence. Various pharmacological and non-pharmacological treatments are used in the management of incurable dementia, and the treatments are mainly aimed at reducing the behavioral and psychological symptoms of the disease (Tominari et al., 2021; World Health Organization, 2023). Management of dementia is highly individualized and combined treatments are more effective than a single treatment (Tisher and Salardini, 2019). It has been reported that the use of non-pharmacological treatments in the management of the disease will be beneficial because pharmacological agents such as cholinesterase inhibitors, antidepressants, and antipsychotics used in the management of dementia are moderately effective, have high levels of side effects, and have limited applicability. It has been stated that pharmacological treatment should be used in cases where non-pharmacological treatments are insufficient and patients pose a danger to themselves and their environment (Bessey and Walaszek, 2019). Due to the limited effects of pharmacological treatments in the management of dementia, interest in non-pharmacological treatments has increased. Non-pharmacological treatments used in the management of dementia; sensory stimulation (acupressure, aromatherapy, massage, touch therapy, light therapy, gardening activities, music and dance therapy), cognitive and emotion-focused approaches (cognitive stimulation, reminiscence therapy, validation therapy and simulated presence therapy), behavior management techniques, multicomponent interventions and other treatments (patient and caregiver education, exercise and animal-assisted therapy) (Abraha et al., 2017). In this regard, in order to increase the cognition, independence and well-being of individuals with dementia, it is recommended to apply non-pharmacological treatments such as cognitive rehabilitation, cognitive stimulation and reminiscence therapies to individuals with mild/moderate dementia, and attention is drawn to these approaches adapted to the needs and preferences of individuals (National Institute for Health and Care Excellence, 2018). Reminiscence therapy, one of the non-pharmacological treatments, is a popular psychological intervention that involves remembering and discussing past activities, events, and experiences with the help of concrete cues to strengthen participants' memory (Woods et al., 2018, Lodha and Sousa, 2019). Reminiscence studies in individuals with dementia are generally based on Butler's (1963) Life Review model. Butler (1963), reviewing life; He defined it as the recollection of past experiences or events in which individuals reflect their painful and happy memories. In this concept, it is emphasized that life review can help develop a sense of integrity and harmony in the individual and is included in psychotherapy for elderly individuals. With this groundbreaking study by Butler, memories were seen as a dynamic adaptation process, instead of being seen as a problem with older individuals living in the past and brought about a change in professional perspective (Woods et al., 2018).

Official Title
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The Effect of Reminiscence Therapy Applied to Individuals With Dementia on Cognitive Functions, Anxiety, Depression and Activities of Daily Living

Conditions
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Dementia

Intervention / Treatment
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* Other: Reminiscence therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being diagnosed with mild to moderate dementia according to DSM-5 criteria (whether individuals have an official diagnosis of neurocognitive disorder according to DSM-5 criteria and their medical diagnosis will be verified from the health records at the institution), Getting a score between 13-23 for the educated (literate) and 10-23 for the uneducated (illiterate) on the mini mental state examination, Being 65 years of age or older, Being able to communicate, No vision or hearing problems, Consent to participate in the research. Exclusion Criteria: Getting a score below 13 and above 23 for the educated (literate) and below 10 and above 23 for the uneducated (illiterate) from the mini mental state examination, Having an acute illness that prevents participation in intervention sessions, Having serious sensory and physical limitations that prevent participation, Having severe neuropsychiatric symptoms (agitation, psychosis, apathy, uncontrolled delirium, etc.), Having a traumatic life history, Having recently participated in a similar program.

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>The research will be conducted in a pre-test post-test single-group, quasi-experimental research design.In this research, reminiscence therapies will be administered to individuals with dementia in sessions of approximately 45 minutes, once a week for 8 weeks. In order to hold group discussions where life stages are discussed in the program, individuals with dementia will be divided into 4 groups of 7 people each. It is aimed for the groups to be distributed homogeneously. In this regard, 4 groups consisting of similar individuals will be created, taking into account sociodemographic variables (age, gender, etc.) and dementia stage. | Other: Reminiscence therapy<br>* In the research, reminiscence therapies will be carried out once a week for 8 weeks, in sessions of approximately 45 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Cognitive Status on the Standardized Mini Mental Test (SMMT) at Week 8 | SMMT, which allows assessing cognitive status, is the most frequently used and easily applied test in dementia screening. The scale is evaluated out of 30 points in total. For SMMT, scores of 23/24 are considered the cutoff score for dementia, but traditionally scores between 24 and 30 are considered normal. A score below 24 indicates cognitive impairment, between 18 and 23 points is considered mild dementia, between 13 and 17 points is considered moderate dementia, and below 12 points is considered severe dementia. Change = (Week 8 Score-Baseline Score) | Baseline and week 8 | 
| Change from Baseline in Anxiety Symptoms on Geriatric Anxiety Scale (GAS) | GAS,developed for the elderly, is a 30-item scale that has somatic, cognitive and affective subscales and monitors anxiety symptoms. The total score on the scale varies between 0-75. A high score indicates a high level of anxiety.Change = (Week 8 Score-Baseline Score) | Baseline and week 8 | 
| Change from Baseline in Depressive Symptoms on Geriatric Depression Scale Short Form (GDS-SF) | GDS-SF, is a scale consisting of 15 questions that questions the emotional state of elderly individuals. The cut-off point of the scale is 7 points and above. Scores between 0 and 4 indicate no depressive symptoms, scores between 5 and 8 indicate mild depressive symptoms, scores between 9 and 11 indicate moderate depressive symptoms, and scores of 12 and above indicate severe depressive symptoms. Change = (Week 8 Score-Baseline Score) | Baseline and week 8 | 
| Change from Baseline in Patient's Dependency on Basic Self-Care Behaviors on Katz's Activities of Daily Living Index (KADLI) | KADLI, evaluates the patient's dependence on basic self-care behaviors that are required to live and are expected to do every day. The scale evaluates the degree of dependency in basic daily living activity parameters, including information on bathing, dressing, toileting, transfer, continence and nutrition. Scoring of the index ranges from 0 to 6, and a patient with a score of 6 is considered independent, and a patient with a score of 0 is considered fully dependent. Change = (Week 8 Score-Baseline Score) | Baseline and week 8 |