The psychological impacts of nostalgia for people with

dementia: an experimental study

Sanda IsmailProf Richard ChestonDr Gary Christopher

Symptoms• Memory loss• confusion • problems with

speech and understanding

Dementia: a significant health and social threat

• About 35.6 million people have been estimated to have dementia worldwide

• By next year (2015) 850, 000 will be living with dementia in the UK

• This translates into a total cost of £26.3 billion per year.

• There is no cure for dementia…

(Alzheimer’s Society, 2014)

That’s enough to pay the annual energy bill of every household in the country

Dementia goes beyond the neurological process….

It has been regarded as a disease of the entire person rather than a mere illness of the brain

Recent conceptualisations of dementia argue that it

represents an

(Cheston, 2011)

existential threat

Ultimate concerns/ Existential realities

Freedom

Existential isolation Meaninglessness

Death

In this regard….• Dementia increases dependency

and eventually leads to death

• Threatens identity and self-esteem which may ultimately lead to…

• social isolation

• and compromise a person’s ability to find meaning in their life

18% are not living well with dementia

61% felt depressed or anxious recently

60,000 deaths a year are directly attributable to

dementia

40% felt lonely recently

34% do not feel part of their community

28% are not able to make

decisions about how they spend their time

Alzheimer’s Society, 2014

Existential concerns are implicit within the dementia care literature; research literature and clinical literature involving

interventions

Dementia care literature • attachment needs (Van Assche et al, 2013,

Stephens, Cheston and Gleeson, 2013)

• how meaning or purpose in life is established (McGovern, 2012)

• how the potential loss of identity is negotiated (Eustache et al, 2013, Steeman et al, 2013)

Research literature

Various studies have suggested that the early stages of dementia, after receiving a diagnosis, generally cause profound psychological effects on :

• self-esteem (Steeman et al, 2006)

• meaning/ purpose in life (Lingler et al, 2006, Macquarrie, 2005)

• social connectedness (Hatch, 2013)

• general psychological wellbeing (Piiparinen and Whitlatch, 2011).

Clinical literature involving interventions

• Substantial pieces of research by leading dementia care researchers, found very little or no significant effects of these activities on psychological wellbeing for people with dementia (Wang, Hsu and Cheng; 2005;Woods et al, 2005; Wang, Yen and OuYang, 2009; Gudex et al, 2010; Woods et al, 2005; Forsman, Schierenbeck and Wahlbeck, 2011; Woods et al, 2012).

• Reminiscence therapy attempt to use various elements of the past to provide various psychological functions for people with dementia

• However, the efficacies of these activities are still debated

It is therefore not clear which of the active components in these activities significantly contribute to enhancing the psychological equanimity for people with dementia (Moos and Bjorn, 2006).

From a different perspective (existential perspective)

evidence base of counteracting existential threats

nostalgia could be the active ingredient in reminiscence

What is nostalgia?

• Nostalgia is defined as a “sentimental longing for the past” (The New Oxford Dictionary of English, 1998; p. 1266)

• Different from reminiscence and ordinary autobiographical memory

• “One can remember without being nostalgic, but one cannot be nostalgic without remembering” (Batcho, 2007; p. 362).

Aim of the research

To explore the psychological impacts of nostalgic memories compared to non-nostalgic memories on people affected by dementia.

The use of nostalgia by people with dementia to provide desirable psychological functions is not clear and has not been explored among people with dementia

Methodology

SYSTEMATIC REVIEW

PATIENT AND PUBLIC

INVOLVEMENT

3 EXPERIMENTAL STUDY

1 2

Systematic review • Involves the use of systematic,

clear and detailed methods to identify, critically appraise relevant studies and analyse data from such studies in order to answer a formulated question (Moher et al., 2009).

• What is the strength of evidence relating to a range of psychosocial functions of nostalgia including self-esteem, social connectedness and meaning in life within the general population?

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# of reports identified through electronic database searching = 1879 :

MEDLINE= 279; PsychINFO= 768; CINAHL Plus= 99; The Cochrane Library= 3; British Nursing Index= 7; Social Care Online = 3; EMBASE= 271; ScienceDirect= 144; ISI Web of Science= 163; Applied Social Sciences Index and Abstracts (ASSIA) = 109; Social Service Abstracts = 33

 

# of additional reports identified through other sources = 103 :

NRR= 0; UKCRN= 0; SIGLE= 46; Grey Literature Report= 0; The British Library= 14; Index of Conference Proceedings= 0; Zetoc= 14; Southampton Nostalgia Group page = 29; References from included studies = 3

 

 

 

The Psychologist= 0. .

 

 

# of reports = 1985

# of reports screened = 1439

# of reports obtained = 54

# of studies included in the review = 39

# of reports excluded by reading titles = 1309Reasons: They were irrelevant to the hypothesis of the review # of reports excluded by reading abstracts = 76 Reasons for exclusion:27 = explain the concept of nostalgia5 = focus on reminiscence13 = focus on the relationship between nostalgia and consumer behaviour but not psychological outcomes8 = did not focus on any aspects of nostalgia.5 = commentary on other articles, editorial reports or letters to editors of journals4 = could not find or access abstract of articles6 = nostalgia was investigated more as an outcome than an intervention5 = Non-experimental studies.2 = focus on homesickness1 = investigated physiological functions of nostalgia

# of studies in reports assessed for eligibility = 132

# of studies excluded = 93

Reasons for exclusion:44 = Non-experimental studies13= did not investigate targeted psychological outcomes18 = nostalgia was assessed as an outcome6 = characterised features of nostalgia2 = comparing effects of different forms of nostalgia or not comparing nostalgia with ordinary autobiographical memories6 = examine nostalgia proneness3 = cannot access full text

# of reports after duplicates removed = 1439

Flow of information through the different phases of the systematic review

Patient and public involvement (PPI)

• Memory cafés organised by the Alzheimer’s Society in Bristol

• Feedback will be obtained from this group on: the design of the experimental study

the acceptability of the manipulation of nostalgia

ability to identify and provide three favourite nostalgic songs

ability to understand and complete the outcome measures.

Experimental study • This will be done by adapting and extending similar experimental studies looking at the

impact of two specific forms of nostalgia (narrative and music-evoked nostalgia) within the general population.

• Population = people diagnosed with dementia and having mild to moderate cognitive impairment

• Setting = memory clinics

• Sample size = 86

• Independent variable = narrative nostalgia and music-evoked nostalgia

• Dependent variables/outcomes = self-esteem, social connectedness and meaning in life

• Moderators/ mediators = affect, neuroticism, resilience, nostalgia proneness, belongingness orientation, degree of cognitive impairment

Figure 1: Research process showing recruitment of participants, manipulation of nostalgia, data collection and mood repair

Potential participants identified by researcher or clinical staff

Patients meeting eligibility criteria approached and invited to participate in the research and 3 favourite nostalgic songs requested from participants

who wish to take part in the research.

 Consent requested from participants

Randomisation

Manipulation check

Outcomes

Manipulation check

Outcomes

Outcomes

Manipulation check

Outcomes

Manipulation check

Distraction (Word puzzle)

Mood repairMood repair

(Moderators/ Mediators measured)

Narrative nostalgia

Music-evoked nostalgia

Narrative control

Music- control

21

Narrative nostalgia Narrative control

Music-evoked nostalgia

Music- control

212222

Study 1

Study 2

Significance of the research

• Theoretically: strengthen arguments perceiving dementia as an existential threat.

• Also, while reminiscence therapy is frequently used with people with dementia, research findings are unclear as to whether this has any benefit. It may be that one of the factors determining whether reminiscence is of benefit is whether or not a nostalgic memory is evoked

• Clinically: may be able to shed light on the way in which nostalgia buffers the psychological challenges of living with dementia

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