INTRODUCTION

In Taiwan, the elderly population currently constitutes 10.43% of the total population, and is estimated to increase to 20.67% by 2027. 1 Because of the rapid growing of elderly population, more elderly care facilities are established to fulfill caring needs of this group of people. Yet, institutional care for elders in Taiwan remains to satisfy basic physical needs, services providing for the psychosocial well-being of institutionalized elders are less emphasized. Reports from the Taiwan Alzheimer Disease Association (TADA) identified that roughly 24.5-65.7% of residents residing in long-term care facilities in Taiwan have cognitive impairments. 2 Older people with dementia often exhibit depressive symptoms, numerous functional impairment and behavior problems. [3][4][5][6] Thus, interventions to manage these problems in dementia elders are imperative in order to improve the health and quality of life of elders. Earlier in 1996, Woods had identified that reminiscence intervention can provide cognitively impaired individuals with opportunities for social interaction and enjoyment. 7 Only three studies used reminiscence as a care modality for depressed mood, functional impairment and behavior competence of elders with dementia have been addressed. Baines et al. 8 and Thorgrimsen et al. 9 (2002) used reminiscence therapy for behavioral outcomes of a small group of dementia elders; Goldwasser et al. 10 measured physical functioning in elders with dementia post reminiscence intervention. Therefore, we conducted a clinical trial with larger sample size to test the effects of group reminiscence therapy on depressed and demented residents of long-term elderly care facilities and to measure the outcome of such intervention on depressive symptoms, cognitive status, behavioral competence, and functional abilities of dementia subjects. 11,12

THE INTERVENTION

In our large research project, the experimental subjects received eight group sessions, one session a week, over an eight week period. Each session lasted up to 60 minutes. Each of the eight sessions had a different theme and was led by one facilitator colead with one co-facilitator. 11 The themes included "First meeting," "Childhood experiences," "Old time flavor," "Old time music," "Festivals," "My family," "Younger age," and "My achievements." 11 In the first meeting, group members introduced themselves to each other and rules of group participation were announced. The following seven sessions, a variety of themes based on a previous focus group interview among 8 institutionalized elders were explored. Childhood experiences include toys long ago for Taiwanese children such as, to mold clay figurines, to make and spin a whipping top, to make bamboo whistle and bamboo dragonfly, to build up earthenware caves, and to play jumping rope, paper cards and sand bag. Old time flavors such as sweet potato soup and sweet potato rice, green bean soup, sticky rice cake were reminiscing. Sweet potato served as principal food among older Taiwanese generation. Therefore, sweet potato food products became a favorite topic in group discussion. Old time music include both Taiwanese and Japanese old songs due to Japanese colonial rule. Then, the session on Festivals include a number of traditional Taiwanese holidays. They are Lunar Chinese year, Dragon boat festival, Tomb-sweeping Day, Mid-Autumn festival, Mid-winter festival, Mid-Summer Ghost Festival. Taiwanese people have special activities for the above festivals. For example, in Dragon boat festival, people go boating on a boat with dragon sculpture and eat bamboo-leaf rice. In the session of My family, elders were invited to share their family life and members in group. Memory triggers such as photographs, household and other familiar items from the past, old time music, and old time flavor of food were used. In the session of Younger age, themes related to fortunate and unfortunate life events such as grief in separation with Mainland family members, heroic fighting in a war, poverty and difficulty, childhood games and friends and to feel sorry for a person or something involved in a mishap. Other themes related to historical events include World War II, Japanese colonial rule and counteract with Japanese, Taiwan Restoration at end of the Qingn Dynasty and in the early Republic of China were also induced.

EFFECTS OF INTERVENTION

The reminiscence intervention demonstrated effects for alleviating depressive symptoms and cognitive impairment, however it did not show any effectiveness on increase in behavior competence and physical functioning in elders with dementia. 11,12

CONCLUSION

The following limitations are acknowledged for future research. Each study site had both intervention and control participants and interaction between participants and outside visitors was possible and could threaten internal validity. Also, long study duration over a period of one year can be another threat to internal validity. Finally, subjects with excessive disruptive behavior problems were excluded, while such individuals may in fact benefit from the intervention. 12 Participation in reminiscence activities is a positive and worthwhile experience for dementia elders. Caregivers must consider the specific cultural values and experiences of older people in around the world. We need to evaluate and design interventions targeting the health needs of older adults, especially those residing in long-term care facilities. Reminiscence offers a method of promoting healthy aging.