Why reminiscence is good for us all

Reminiscence activities focus on the history of ordinary people and really value their experience.

Reminiscence Activities

If you are wondering if reminiscence really works and need some convincing about its real value to people, here's a report by the Economic and Social Research Council.

in 2003, they did a piece of research on reminiscence with 142 older people. Their research certainly reflects my own experience over the last twelve years and also that of our REAL Communication workshops and life story work with residents in care homes across the country.

You can find more articles and research at their website.

 

Evaluating the Impact or Reminiscence on the Quality of Life of Older People

Reminiscence has been defined as 'the vocal or silent recall of events in a person's life, either alone, or with another person or group of people'. Anecdotal evidence suggests that reminiscence can improve the well-being of older people, but there have been very few substantial studies. In our study, 142 older people living in care settings participated in an evaluation of the impact of reminiscence on quality of life. We assessed our participants' quality of life before and after the intervention, and changes in their quality of life over the period of the intervention were compared with those found in a group of older people who were not involved in any reminiscence intervention (the control group). We also carried out interviews and focus groups with care staff, older people, and family carers of older people, to establish their views and feelings on reminiscence.

KEY FINDINGS

Reminiscence activity results in psychological benefit for older people. Older people in our study who participated in activities were found at the end of the period of intervention to have better psychological morale and less psychological morbidity, and show more positive emotion and less negative emotion, than older people in our study who had not participated in our activities.

The level of psychological benefits obtained through involvement in activities did not differ significantly due to the nature, context, and form of the activities; this suggests that the benefit obtained is related more to the process of engagement in meaningful activity than to specific aspects of that activity, such as thinking or talking about the past.

Older people's cognitive impairment was neither a barrier to involvement in reminiscence-type activities, nor an influence on benefiting from that involvement. Interviews and focus groups with older people and formal and informal carers indicated that reminiscence helped in 'building identities and sharing lives'. However, reminiscence could also highlight 'discontinuities' for the older person, e.g. that the present was not a world to which they belonged.  Engagement with feelings of discontinuity might be more beneficial for older people than reminiscence work by itself. Care staff expressed concern that social care (talking, listening, sharing) with older people is not recognised as 'real work' within care organisations.  If potentially difficult interactions focusing on meaningful issues are to occur between carers and older people, there must be organisational and managerial recognition that 'just talking' is an important component of social care, and a commitment to and investment in adequate staff training.

BACKGROUND

There has been a growing interest in the benefits of reminiscence for older people's quality of life (QoL). Reminiscence has been defined as 'the vocal or silent recall of events in a person's life, either alone or with another person or group of people' (Woods, Portnoy, Head and Jones, 1992, p.138). A special form of reminiscence, life review, has been defined as 'the process of reviewing, organising and evaluating the overall picture of one's life' (Woods et al., 1992, p.138). As yet, the evidence that these forms of activity have positive effects on the well-being of older people is still slight (Spector, Orrell, Davies and Woods, 2002).  Both reminiscence and life review might be considered special examples of a general process known as disclosure, the process whereby thoughts and feelings about stressors and meaningful events are expressed. The benefits of this process to the individual have been comprehensively demonstrated by Pennebaker and his colleagues across an impressive range of outcomes and contexts (Traue and Pennebaker, 1993). There was therefore sufficient research to justify our study, which evaluates how reminiscence-type activities impact upon older people's QoL, and how the conditions under which reminiscence occurs influences that impact.

RESULTS

Most of our participants enjoyed everyday reminiscing. The enjoyment of reminiscence was associated with a higher level of participation in activities, a preference for the company of others, a higher level of contact with friends, and lower levels of psychological problems. Older people who enjoyed reminiscing tended to report having engaged in reminiscence recently; however, older people who reported regrets (nearly half of our participants) also reported having reminisced recently, and such people had lower morale and lower levels of positive displayed emotion. A picture emerges of two sub-groups of older people: one group enjoys reminiscence as a pleasant, sociable activity; while the other group reminisces primarily in relation to the regrets they have about their lives.

Following involvement in our activities, based on the principles of reminiscence, life review, or disclosure, our participants displayed significantly improved levels of several aspects of QoL, relative to our control group. Specifically, over the period of assessment, intervention participants had higher morale and reduced psychological morbidity relative to control participants, and more positive affect and less negative affect relative to control participants. Figure 1 displays the change in levels of negative affect over the period of the intervention as displayed by our participants. Both intervention and control participants showed a decrease in levels of negative affect across the assessment period. However, this decrease was only significant in the intervention participants (t(89)=-2.73, p=.004). The association between condition membership and change in negative affect was also significant, such that relative to the control participants, the intervention participants showed a significant decrease in levels of negative affect (sr(106)=-.19, p=.023).

We found relatively little evidence that the exact nature of the intervention - reminiscence, life review, or disclosure; in groups or one-to-one; using talk or writing - had any significant effect on QoL outcomes. While our participants' cognitive impairment was not significantly improved by our activities, people with lower levels of cognitive impairment were just as beneficially affected by involvement in our activities as those with higher levels.  We carried out an exploratory study of using a writing- based form of reminiscence activity with older people who were required to work alone. While few older people felt able to work in this way, those who did participate (n=5) responded enthusiastically, suggesting several benefits of this process for the participant.

The views expressed by older people and their carers in focus groups and interviews indicate that reminiscence can give identity and significance to the older person. The key themes that emerged from the analyses of the focus group transcripts were found to operate at three different levels.

Level one themes demonstrated how both past and present talk are key in constructing who we are, and in getting to know others - sharing lives is a central theme in building relationships. At the second level, everyday talk concerning the past appears to offer overlapping but unique benefits, including intergenerational benefits such as preserving family folklore, which offers a sense of significance and identity to older people, families and carers. Listening to someone's past can give a sense of significance in the present - a feeling of being valued and that you really matter. Interviews with some of the oldest old participants in our study indicated that the value placed by older people on reminiscence shared with family members (and younger generations) may differ from that placed on reminiscence with same-aged peers. This is due to the importance for older people of family relationship maintenance and the continuity of one's life history across family generations. This needs to be considered when planning reminiscence activities.  At the third level, whilst past and present talk help people to share lives and feel valued, there are tensions that can impede this process. Staff recognise that the past can be distressing and they may not have the skills or time to address sensitive memories confidently. Having the time to listen and talk requires organisational commitment to value social care and not to dismiss social care as 'just chatting'. With regard to older people, there were indications of unhappiness with their current lives, with older people often feeling displaced or cut off in their present world. Listening to concerns in the present might be more meaningful to some older people than a focus on the past. Activities encouraging meaningful linkage of the past with the present are essential in challenging feelings of a discontinuity with present life that were expressed by our participants.

CONCLUSIONS

After involvement in our activities the intervention participants had higher morale and more positive displayed emotion, and reduced psychological problems and less negative displayed emotion, relative to the control participants who had not taken part in our activities. There was little evidence that the type, context, or form of our activities substantially affected the benefits our participants obtained. Most importantly participants engaged in reminiscence or life review did not benefit to any greater extent than those participants engaged in disclosure.  Reminiscence as an activity differs from reminiscence as therapy. Activities should recognise diversity - reminiscence may not be appropriate for all older people. To maximise psychological benefits, activities should form part of an individualised ongoing programme of care.  A positive emphasis on social care should make explicit the skills and functions involved in 'just talking'. Promoting the use of 'just talking' as a legitimate form of social care may encourage carers to harness potential benefits of everyday interactions relating to both the past and the present.

However, care staff and family members should be additionally encouraged to address discontinuities of the self in the present in older people, rather than place too much emphasis on the past.  Writing may be a challenging activity for older people and care staff. However, writing helps maintain important skills, and the work produced can give the older person a sense of achievement and help facilitate relationships with residents, care staff and family members.

ABOUT THE STUDY

One hundred and forty two older people, living in a number of residential and nursing homes, took part in our study. After participants had consented to be involved in our study, we assessed indicators of their QoL, such as psychological morale and morbidity, and observed negative and positive affect (emotion). After two weeks, we went back and provided them with an hour-long, once-weekly reminiscence-based activity over a four week period. We then assessed our participants' QoL at the end of our final activity session, and returned a month later to assess QoL one last time.

Our activities were designed so that the 'intervention' participants (n=118) received either a reminiscence, life review, or disclosure activity. These activities occurred in either a group context with other participants, or in a one-to-one context with the researcher. Finally, the activities were either in a talk-based format, or primarily involved writing in booklets. The reminiscence and life review activity sessions followed a standard format adapted from Bornat (1994) and Haight (1992) respectively, while the disclosure activity sessions were developed within Pennebaker's (Traue and Pennebaker, 1993) theoretical framework through a period of pilot work. The disclosure sessions were differentiated most clearly from the reminiscence and life review sessions by the formers' focus on the present and future. A schedule of questions and verbal prompts was developed for each session, and objects, photographs, poems and extracts from local history documents were employed as props and guides. In all three activities a programme of topics covered the four weeks of the activity. Materials were adapted so as to be applicable whether the sessions were being run in one-to-one or group contexts, or employing a verbal or written format.  With some participants (our 'control' group, n=24), we only assessed QoL - no activity was provided.  This was because we wanted to see how QoL changed in older people who received an activity compared with older people who did not receive an activity.

We carried out seven focus groups with care staff, older people, and relatives of our participants. We also carried out interviews with 18 older people. The focus groups and interviews were to help us understand the barriers, benefits and opportunities to reminiscence that existed in everyday interactions between older people and their carers. Kevin McKee, Fiona Wilson, Helen Elford, Fiona Goudie, Man C. Chung, Gillie Bolton and Sharron Hinchliff.

Person-focussed and relationship-centred care benefits everyone and reminiscence activities and conversation should sit at the heart of this.

"Reminiscing celebrates the richness of life experience, allowing in the process and the voice of the person to be communicated, however it is expressed". (Journal of Dementia Care 2001)

Many older care home residents may only be able to give their carers a small piece of themselves - all there is for them, at that moment. That fragment is to be treasured, for it may become a strand or thread that also becomes part of carers' lives as well and may, like a tapestry, gradually be woven together to create something new and vibrant.

Reminiscence through conversation and reminiscence activities provides immense pleasure and interest for older people, and makes a valuable contribution to the knowledge of carers. By placing emphasis on a person's identity and unique experiences, the relationship between carer and cared-for can be significantly improved by creating greater relevance and connectedness. Insight into a person's history and life stories makes caring for them more meaningful and satisfying.

Even when reminiscence activities and conversation take place in a group, the exchange between people and comparing of experiences enriches the lives of those who live together, but often oddly separate – and can encourage a greater sense of community among them.

Research into the value to families and friends of reminiscence activities and conversation also demonstrates the real value of connecting with people from differing generations not only in terms of learning about the past but also improving the relationships between the family and friends, the older person and their carers. To discover something of interest about a family member's past also brings benefits to the family themselves. And links between the person's past experience and present behaviour can be revealed in ways that helps to assure that their care is most appropriate.

For those who have grown up in another country or culture, whether old or young, carer or cared-for, reminiscence activities and conversation provide a passport to closer understanding by acknowledging and valuing people's differing experiences in a way that no other activities do.

Here are some extracts from Sarah Housden’s seminal book ‘Reminiscence and Lifelong Learning’ published by NIACE in 2007:

"Over the past few years, much has been written and spoken about demographic changes leading to an increasingly ageing population. The value of oral history lies in the fact that it moves the focus of history from powerful to ordinary people. Instead of an essentially political history, concerned with power-struggles between a few high-ranking figures, and generally being written from the point of view of those who came out on top, oral history opens up new areas of inquiry, looking at what was important to individuals and groups not normally represented in historical accounts, and using the voices of ordinary people without demanding that they have any qualifications other than that they were there and experienced the things of which they speak. Thus the barriers between historians and those they write about are broken down, as well as social barriers, and barriers between generations.

Oral history also widens the scope of history to include emotions and feelings. This enlarges and enriches the scope of historical writing, enabling the reader to become imaginatively involved in what it was like to be there and to live through particular events of the past. It allows the historian to look at things from a number of differing points of view, reflecting the fact that reality is complex and many-sided. It therefore provides a more fully rounded, realistic and fair reconstruction of the past which can be a challenge to the established account. A voice is given to the defeated as well as to the victorious, making oral history essentially more democratic and bringing recognition to groups who have previously been ignored. It is becoming clear that the memories of older people today have an important role in constructing accounts of historically significant events as well as conveying aspects of everyday life which can contribute to an understanding of social history.

Reminiscence

Reminiscence has come to be seen as a beneficial and potentially therapeutic activity for people of all ages (Bender et al, 1999). ...at this point it is important to note that some of the benefits of reminiscence derive from its similarity to oral history and lifelong learning, in that it values the experience of the individual

Until the 1960s talking about the past was considered to be a sign of withdrawal, degeneration and deterioration in an older person and so was discouraged in health and social care settings. Instead, much emphasis was put on maintaining older people’s orientation to present realities, possibly to the detriment of their psychological well-being as they were dissuaded from talking about things which had been important to them throughout their lives. This view began to change in 1963 when Robert Butler published an article on reminiscence and life review pointing out some potential benefits to older people of remembering the past. From that point on, the views of health and social care professionals took a gradual about-turn, until reminiscence was seen as a ‘therapy’ in the 1980s. Subsequent opinion has taken a step back from this, stating that although reminiscence can have ‘therapeutic effects’, it is not a ‘therapy’ as it is not a proven treatment for a particular medical condition (Gibson, 1998: 15).

In the 1980s reminiscence became popular in day centres and residential homes for older people with the publication of Help the Aged’s ‘Recall’ series. Slides were shown together with commentaries on how life used to be, stirring up the memories of older people and stimulating discussion around their own memories, thus enhancing interaction and activity levels (Bornat, 2002b: 2). It is from this movement that the current interest in and practice of reminiscence has drawn inspiration. Reminiscence today consists of a range of social and creative activities undertaken mainly in small groups with the purpose of enhancing the wellbeing of older learners. The exact nature of how it is undertaken will become clear in subsequent chapters, together with the fact that at the heart of reminiscence activities is the high value placed on individual learners’ memories.

Reminiscence is a useful activity in ‘the development of human potential’ because it recognises the value of every contribution a learner makes to the group. Older people living in residential homes often feel that they have reached the end of any useful purpose in their lives – a feeling which is not entirely unjustified given the lack of meaningful activities and purposeful roles available to them. Sitting around all day doing nothing can only have a detrimental effect on people’s physical, mental and spiritual health. Apathy sets in, taking away the motivation to do something for themselves to make life more fulfilling. Reminiscence provides a way of moving people away from this inactivity, enabling them to discover that they still have the potential to make a valuable contribution within their current environment.

Inactivity leads to the deterioration of human potential. An activity like reminiscence can lead to its growth and development. It is a particularly useful activity with those who have been inactive and need a boost to their confidence. Participation can be progressively graded, so that individuals, who begin by looking at and thinking about items of memorabilia, can move on to making a written or pictorial account of their memories./p>

Reminiscence can be ‘supportive’ in that it gives individuals the opportunity to review their personal histories and tackle any unresolved issues from the past. The learning that takes place through this process leaves individuals in a stronger place to deal with current difficulties. This is clearly a lifelong process, and for many people it can be made easier by having the support of a reminiscence group. Support comes from other learners through their listening and through the telling of their own stories as participants gain insight from each other. Having said this, it should be noted that reminiscence is not a form of psychotherapy, and there are limitations to the sort of problems that can be tackled in this way. Reminiscence is also a supportive process in that it does not put pressure on individuals to perform beyond their level of confidence and competence. By listening carefully to the contributions of each learner, the tutor indicates the value of what they are saying and encourages them to go on taking part.

Older people often feel incapacitated in the modern world through their lack of knowledge of such things as computer technologies. The wisdom they have acquired through years of experience can seem inferior to knowledge about fast moving computers, and one role that reminiscence can have is to reaffirm the importance of such hard-earned wisdom. Through discussion about working life and such things as traditional handicrafts, recognition is given to the skilled craftsmanship practised throughout their lives. At the same time, reminiscence can be used to enable people to develop new skills.

Many people come to reminiscence groups with very little confidence in their ability to contribute anything, often saying that they just can’t remember anything. Older people with cognitive impairments tend to be exposed to a whole battery of ‘memory tests’ by doctors and psychologists. The effect of this is to emphasise that they are losing their memories, and the low self-esteem and depression this can cause can contribute to the general picture of cognitive decline. Reminiscence puts the emphasis in a completely different place by concentrating on what people do remember. This can be a tremendous boost to self-confidence and contributes to the overall enjoyment of the activity. Reminiscence recognises the fact that there are different forms of remembering. While someone may not be able to answer direct questions, they often find that their memories come flooding back when they are exposed to memorabilia and other sensory stimuli.

Firstly, while it is clear that reminiscence can be a useful learning experience in many ways, it is also true that not everybody enjoys it. In fact, some people find it detrimental to their emotional well-being, sometimes because they have traumatic memories which they have not dealt with. Another difficulty is that for reminiscence to be as beneficial as possible, it does need to take place over a long period of time.

One key factor making reminiscence relevant to people of all abilities, and for the entire lifespan, is that it ranges from very simple activities to the more complex. It therefore has a very significant place in providing learning opportunities throughout life.

Again, by valuing people’s memories, life experiences can take on new levels of meaning and significance, both in the individual’s and the listener’s eyes, as well as within the wider community.

Person-centred care in dementia

The person-centred approach has been applied in counselling and care settings as well as to education, and is of significance in our consideration of the place of memories in lifelong learning.

Tom Kitwood (e.g. 1997) has advocated the importance of seeing people with dementia as people first. Having dementia is of secondary importance to the way we see individuals, and while it is important to consider the special needs which arise because of the condition, it does not define them as people. Most people with dementia will have significant memory problems, beginning with loss of short-term memory. Memories of the more distant past may stay intact for years after short-term memory begins to deteriorate. Listening to, working with and recording what a person has to say about their life experiences is an essential way of demonstrating their value as a person – both to them and to those around them. By including people with dementia in reminiscence groups, emphasis is placed on what they can still achieve and take part in, rather than on the skills they have lost. This also demonstrates that participation in learning can truly be ‘lifelong’ and needn’t stop at the point of deterioration of cognitive abilities."

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