1. Reminiscence Therapy for Older
Adults with Depression and Dementia
Living in Residential Care
April Hillquist

2. Overview
• Introduction
• Psychosocial Factors for Older Adults
• Ageism and Social Justice
• Sources of Literature
• Depression
o Dementia
o Residential Care
• Reminiscence Therapy (RT)
oReminiscence Functions
o RT, Dementia and Depression
o Types of Reminiscence
 Instrumental Reminiscence
 Integrative Reminiscence

3. Introduction
In 2013, one in four people in the U.S.
were over 65.
• 14.5% of the total population
oBy 2060, this number will double
U.S. Department of Health and Human Services
Administration on Aging (2015)
Critical life events have a significant effect on
older adults
(Korte, Bohlmeijer, Westerhof, & Pot, 2011; Westerhof,
Bohlmeijer, & Valenkamp, 2004).

4. Psychosocial Factors that can contribute to
depression in older adults:
• Outliving spouse, friends & children
• Loss of support systems
• Losing/Giving up driving privileges
• Isolation and loneliness
• Poverty/Financial stress & uncertainty
• Limited mobility
• Serious illness
• Inability to perform activities of daily living
(ADLs): eating, bathing, grooming, toileting (Rogers, 2013)
• Neurocognitive Disorders (NCDs) - dementia

5. Americans tend to characterize “old age”
with members of society who have not aged
successfully, or have outlived successful
living.
• Marginalized and devalued
• Feelings of invisibility
• Not worthy of notice
• Spoken to in patronizing manner
• External oppression is internalized
(Butler, 2013; Barnhart & Peñaloza, 2013; Larabee, 2013)

6. Ageism and Social Justice
Ageism:
“The invalidation and discrimination against
older persons because of age, or factors
accompanying age” (Larabee, 2013, p. 572).
• Usually the result of one’s fear of aging
• Professionals may ignore depression as a result
Depression is NOT a natural part of aging
Social Work Practitioners “challenge social
injustice…..on behalf of vulnerable and
oppressed individuals and groups of people”
(National Association of Social Workers, 2008)

7. Sources of Literature
Government and Agency Websites:
• U.S. Department of Health and Human Services Administration on Aging (DHHS-
AoA); National Institute of Mental Health (NIMH); Centers for Disease Control and
Prevention (CDC); National Associate of Social Workers (NASW); and the Alzheimer’s
Association.
Books:
• Social work textbooks, and the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5).
Peer-reviewed Journal Articles:
• The majority of this research came from peer-reviewed journal articles; which
consisted of quantitative, qualitative, quasi-experimental, and mixed-methods
research approaches, as well as meta-analyses and one review.
o Additionally, this research used assessment measures with proven reliability and validity

8. Depression in Older Adults
Depression is characterized by:
• A sense of hopelessness, self-criticism and blame, lack of
interest in life, sadness, poor concentration, and appetite
and sleep disturbances.
(Chao, Lui, Wu, Jin, Chu, Huang, & Clark, 2006, p. 37).
Older Adults have greater propensity for depression due to
chronic medical conditions and side effects from prescribed
medications (NIMH, 2015).
Depression is a treatable condition, which is frequently
overlooked and untreated in older adults
• African Americans being the largest ethnic group
(Bohlmeijer, Smit, & Cuijpers, 2003; Hancock, Woods, Challis, & Orrell, 2006;
Korner, Lauritzen, Abelskov, Gulmann, Brodersen, Wedervang-Jensen, &
Kjeldgaard, 2006; Shellman, Mokel, & Hewitt, 2009)

9. Depression and Dementia
Dementia in DSM-IV = Major NCD in DSM-5
Diagnostic criteria for Dementia include:
• Cognitive impairments (CIs), as evidenced by
significant cognitive decline
• Decreased willingness to participate
• Anxiety and Depression
(Diagnostic and Statistical Manual of Mental Disorders, 5th edition, 2013)
Depression is more prevalent in people with
Dementia
• This comorbidity involves more severe CIs
(Hudon, Voyer, Tremblay, Tardif, & Carmichael, 2010)

10. Depression and Dementia
If depression in older adults is
ignored and untreated, it could
possibly lead to suicide
• Older Adults have highest rate of
suicide completion compared to all
other age groups
(Rogers, 2013; Shellman et al., 2009).
• White males comprise 80% of
suicide completion
(NIMH, 2015).

11. Depression and Residential Care
An estimated 26% to 43% of older adults
in residential care in the U.S. suffer from
some form of depression
(Chao, et al., 2006).
Older Adults do not feel like they are
receiving suitable support to meet their
needs, which causes psychological distress
– untreated anxiety and/or depression.
(Alzheimer’s Association, 2014; Hancock et al., 2006).

12. Reminiscence Therapy (RT)
Reminiscence:
• Process of recalling and sharing
autobiographical memories
Reminiscence Therapy
• Created for older adults as an alternative to
traditional psychotherapy
(Watt & Cappeliez, 2000)

13. Reminiscence Therapy (RT)
Reminiscence Therapy Group Work:
• Allows people from a similar
generation to discuss shared
memories
oReduces/prevents depression
oIncreases life satisfaction
Specific to individuals with Dementia:
• Engages them through social interaction
o Improving memory and self-identity
• Improves cognitive abilities
(Huang, Li, Yang, and Chen, 2009; Wang, 2007).

14. Webster’s Reminiscence Functions (1997)
These discussion strategies include:
1. Boredom Reduction (reminiscing when under-stimulated)
2. Death Preparation (in evaluating our own mortality)
3. Identity (reminiscing about who we are)
4. Problem Solving (past strategies to be used in the present)
5. Conversation (used to connect with others)
6. Intimacy Maintenance (dwelling on deceased person)
7. Bitterness Revival (to maintain negative thoughts and emotions)
8. Teach/Inform (to teach a moral lesson)

15. Types of Reminiscence
Based on their work in reminiscence, Watt
and Wong (1991) determined there were
different types:
• Narrative Reminiscence
• Transmissive Reminiscence
• Escapist Reminiscence
• Obsessive Reminiscence
• Instrumental Reminiscence
• Integrative Reminiscence

16. Types of Reminiscence
Two types of Reminiscence found to produce
positive outcomes in older adults
1. Instrumental Reminiscence
2. Integrative Reminiscence
Studies compared Instrumental Reminiscence
to Integrative Reminiscence
• Integrative Reminiscence statistically significant
reduction in depressive symptoms, compared to
Instrumental Reminiscence
• Results lasted longer
(Karimi, Dolatshahee, Momeni, Khodabakhshi, Rezaei, & Kamrani,
2010; Watt & Cappeliez, 2000).

17. Integrative Reminiscence
Integrative Reminiscence helps clients create a more
balanced and realistic interpretation of past events
through cognitive reconstruction
• Reframing life review
• Addressing causes and consequences of negative events
• Challenging and changing negative schemas
• Emphasizing positive thinking and accomplishments
• Highlighting past coping strategies
• Identifying meaning in life
o Creates continuity with the past
• Building confidence in internal sources of self-worth
o Rather than reliance on external ones

18. Conclusion
• Older adults have a greater propensity for
depression because of life events
• Depression is NOT a normal part of aging
o Ageism perpetuates this myth
• People with Dementia have a higher
prevalence of depression
o Which can affect cognitive functioning
• Reminiscence therapy – specifically
Integrative Reminiscence, has the most
success at reducing depressive symptoms
• Depression is a treatable condition
oCannot continue to be overlooked

19. References
Alzheimer’s Association. (2014). Behaviors: How to respond when dementia causes unpredictable behaviors. Retrieved from https://www.alz.org/national/documents/brochure_behaviors.pdf
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Barnhart, M., & Peñaloza, L. (2013). Who are you calling old? Negotiating old age identity in the elderly consumption ensemble. Journal of Consumer Research, 39, 1133-1153.
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