Coping with the increasing number of people with dementia is likely to be one of the major challenges for health systems globally in coming years and decades. There are several Cochrane Reviews of ways to treat or alleviate this condition and an updated review in March 2018 looks at the evidence for reminiscence therapy. We asked lead author, Bob Woods from Bangor University in Wales, to summarise the findings in this podcast.
John: Hello, I'm John Hilton, editor in the Cochrane Editorial and Methods department. Coping with the increasing number of people with dementia is likely to be one of the major challenges for health systems globally in coming years and decades. There are several Cochrane Reviews of ways to treat or alleviate this condition and an updated review in March 2018 looks at the evidence for reminiscence therapy. We asked lead author, Bob Woods from Bangor University in Wales, to summarise the findings in this podcast.
Bob: People with dementia often recall events and experiences from the past, whilst typically not learning new information. Drawing on this, reminiscence therapy has been widely used in dementia care for many years. It aims to prompt past memories, stimulate mental activity and improve well-being. A variety of memory triggers are used, such as pictures, music, video clips and memorabilia. It can take place in a group or one-to-one, and might lead to some form of individualised life-story book.
We investigated whether reminiscence therapy made a difference for people with dementia and their carers on a range of outcomes, including quality of life, performance on cognitive tests, communication and mood. We explored whether any effects depended on whether the reminiscence took place in a group or one-to-one, and whether the people with dementia lived in care homes or in the community.
We now include a total of 22 randomised trials, involving nearly 2000 people with dementia, and combined results from 16 trials, which, overall, we considered to be well-conducted. The combined results, based on approximately 1700 patients, did not show any consistent benefit for reminiscence therapy on quality of life, but there was a small effect on performance on cognitive tests, which was roughly equivalent to preventing 6 months decline in cognitive function in the average person with dementia.
The living situation of the person with dementia and the type of reminiscence therapy used did appear to make a difference, contributing to high variability in the results from different trials. Notably, there was a small improvement in quality of life for care home residents and cognitive performance was also enhanced for them, and cognition also improved if individual reminiscence was used. Individual reminiscence was probably associated with small improvements in depressed mood, whereas group reminiscence and a community setting were probably associated with better communication and interaction.
No benefits for family carers were identified, despite several studies seeking to include family carers alongside their relatives with dementia in joint reminiscence groups. We found no evidence of harmful effects of reminiscence for the people with dementia themselves, but there was a suggestion of slightly increased anxiety in family carers attending joint reminiscence groups.
In summary, when considering current evidence for the use of reminiscence therapy in dementia care, we must be mindful of the type of reminiscence approach being adopted, and the living situation of the participants. We cannot assume that reminiscence will always be beneficial, and we need to develop the evidence-base for different approaches and different groups of participants. However, there is now a body of research that indicates reminiscence can lead to small improvements in quality of life, cognition, communication and possibly mood in people with dementia, in some circumstances.
John: If you would like to delve deeper into this research, you can find Bob’s review in the Cochrane Library. Just go online to Cochrane Library dot com and search 'reminiscence and dementia'.