The psychological impacts of nostalgia for people with dementia

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Dementia has been recognised as a significant health and social threat which is increasingly affecting individuals, families and societies. Recent conceptualizations of dementia argue that it represents an existential threat that is more than a series of technical challenges to the skill of carers. In this regard, dementia increases dependency, threatens identity and self-esteem which may ultimately lead to social isolation and compromise a persons ability to find meaning in their life. While reminiscence therapy is frequently used with people with dementia, research findings are unclear as to whether this has any psychological benefits. With convincing evidence from experimental psychology, it may be that one of the factors determining whether reminiscence is of benefit is whether or not a nostalgic memory is evoked. Nonetheless, this has not been investigated among people with dementia. The main aim of this research is to explore the psychological impact of nostalgic memories compared to non-nostalgic memories on people affected by dementia using a randomised controlled experimental study. By investigating this, the research may be able to shed light on the way in which nostalgia buffers the psychological challenges of living with dementia. For instance, we may be able to identify more precisely how to help people with dementia maintain a psychological equilibrium, and thereby improve their quality of life and psychological wellbeing.

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<ul><li> 1. The psychological impacts ofnostalgia for people withdementia: an experimental studySanda IsmailProf Richard ChestonDr Gary Christopher</li></ul> <p> 2. Symptoms Memory loss confusion problems withspeech andunderstanding 3. Dementia: a significant health and socialthreat About 35.6 million people have been estimated to havedementia worldwide By next year (2015) 850, 000 will be living with dementiain the UK This Thats translates enough to pay into the annual a total energy cost bill of of every 26.3 household billion in the per countryyear. There is no cure for dementia(Alzheimers Society, 2014) 4. Dementia goes beyond theneurological process.It has been regarded as adisease of the entire personrather than a mere illness ofthe brain 5. Recent conceptualisationsof dementia argue that itrepresents an(Cheston, 2011) 6. Ultimate concerns/Existential realitiesFreedomDeathExistentialisolation Meaninglessness 7. In this regard. Dementia increasesdependency and eventuallyleads to death Threatens identity and self-esteemwhich may ultimatelylead to social isolation and compromise a personsability to find meaning in theirlife60,000 deaths a year aredirectly attributable todementia18% are not living well withdementia61% felt depressed oranxious recently40% felt lonely recently34% do not feel part of theircommunity28% are notable to makedecisionsabout howthey spendtheir timeAlzheimers Society, 2014 8. Existential concerns are implicit within the dementia careliterature; research literature and clinical literature involvinginterventionsDementia 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 isnegotiated (Eustache et al, 2013, Steeman etal, 2013) 9. Research literatureVarious studies have suggested that the early stages ofdementia, after receiving a diagnosis, generally causeprofound 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). 10. Clinical literature involving interventions Reminiscence therapy attempt touse various elements of the pastto provide various psychologicalfunctions for people withdementia However, the efficacies of theseactivities are still debated Substantial pieces of research by leading dementia care researchers, found verylittle or no significant effects of these activities on psychological wellbeing forpeople 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). 11. It is therefore notclear which of theactive componentsin these activitiessignificantlycontribute toenhancing thepsychologicalequanimity forpeople withdementia (Moosand Bjorn, 2006). 12. From a differentperspective (existentialperspective)evidence base ofcounteracting existentialthreatsnostalgia could bethe activeingredient inreminiscence 13. What is nostalgia? Nostalgia is defined as a sentimentallonging for the past (The New OxfordDictionary of English, 1998; p. 1266) Different from reminiscence andordinary autobiographical memory One can remember without beingnostalgic, but one cannot be nostalgicwithout remembering (Batcho, 2007; p.362). 14. The use of nostalgia by people with dementia toprovide desirable psychological functions is notclear and has not been explored among people withdementiaAim of theresearchTo explore the psychologicalimpacts of nostalgicmemories compared to non-nostalgicmemories onpeople affected bydementia. 15. Methodology1 2SYSTEMATICREVIEWPATIENT ANDPUBLICINVOLVEMENT3EXPERIMENTAL STUDY 16. Systematic review Involves the use of systematic,clear and detailed methods toidentify, critically appraiserelevant studies and analysedata from such studies inorder to answer a formulatedquestion (Moher et al., 2009). What is the strength ofevidence relating to a range ofpsychosocial functions ofnostalgia including self-esteem,social connectednessand meaning in life within thegeneral population? 17. Flow of information through the different phases of the systematic reviewIncluded Eligibility Screening Identification# of reports identified through electronic databasesearching = 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 SciencesIndex and Abstracts (ASSIA) = 109; Social ServiceAbstracts = 33# of additional reports identified through othersources = 103 :NRR= 0; UKCRN= 0; SIGLE= 46; GreyLiterature Report= 0; The British Library= 14;Index of Conference Proceedings= 0; Zetoc= 14;Southampton Nostalgia Group page = 29;References from included studies = 3# of reports after duplicates removed = 1439The 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 = 76Reasons for exclusion:27 = explain the concept of nostalgia5 = focus on reminiscence13 = focus on the relationship between nostalgia and consumer behaviour butnot psychological outcomes8 = did not focus on any aspects of nostalgia.5 = commentary on other articles, editorial reports or letters to editors ofjournals4 = 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 foreligibility = 132# of studies excluded = 93Reasons 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 notcomparing nostalgia with ordinary autobiographical memories6 = examine nostalgia proneness3 = cannot access full text 18. Patient and public involvement (PPI) Memory cafs organised by the Alzheimers Society inBristol 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 nostalgicsongs ability to understand and complete the outcome measures. 19. Experimental study This will be done by adapting and extending similar experimental studies lookingat the impact of two specific forms of nostalgia (narrative and music-evokednostalgia) within the general population. Population = people diagnosed with dementia and having mild to moderatecognitive impairment Setting = memory clinics Sample size = 86 Independent variable = narrative nostalgia and music-evoked nostalgia Dependent variables/outcomes = self-esteem, social connectedness and meaningin life Moderators/ mediators = affect, neuroticism, resilience, nostalgia proneness,belongingness orientation, degree of cognitive impairment 20. Figure 1: Research process showing recruitment of participants, manipulation ofnostalgia, data collection and mood repairPotential participants identified by researcher or clinical staffPatients meeting eligibility criteria approached and invited to participate inthe research and 3 favourite nostalgic songs requested from participantswho wish to take part in the research.Consent requested from participantsRandomisationNarrative controlManipulation checkMusic- controlManipulation checkOutcomesNarrative nostalgiaManipulation checkMusic-nostalgiaManipulation checkOutcomesOutcomesOutcomes(Moderators/ Mediators measured)Distraction (Word puzzle)Mood repair Mood repair21NarrativenostalgiaNarrative controlMusic-evokednostalgiacontrol2122 22Study 1Study 2 21. Significance of the research Theoretically: strengthen arguments perceiving dementiaas an existential threat. Also, while reminiscence therapy is frequently used withpeople with dementia, research findings are unclear as towhether this has any benefit. It may be that one of thefactors determining whether reminiscence is of benefit iswhether or not a nostalgic memory is evoked Clinically: may be able to shed light on the way in whichnostalgia buffers the psychological challenges of living withdementia 22. ReferencesAlzheimers Society (2014) Dementia 2014: Opportunity for change . Available from: http://www.alzheimers.org.uk/dementia2014 [Accessed 29 November 2013].Batcho, K.I. (2007) Nostalgia and the emotional tone and content of song lyrics. The American Journal of Psychology [online]. pp.361-381 [04 November 2013].Cheston, R. (2011) Using Terror Management Theory to understand the existential threat of dementia. PSIGE Newsletter [online] 118, pp. 7-15. Available from:http://www.psige.org/public/files/newsletters/PSIGE_118_web.pdf [Accessed 13 May 2013].Coleman, P.G. (2005) Uses of reminiscence: Functions and benefits. [online] [Accessed 19 December 2013].Eustache, M.-., Laisney, M., Juskenaite, A., Letortu, O., Platel, H., Eustache, F. and Desgranges, B. (2013) Sense of identity in advanced Alzheimers dementia: A cognitive dissociation between sameness andselfhood? Consciousness and Cognition [online]. 22 (4), pp.1456-1467 [Accessed 15 January 2014].Forsman, A.K., Schierenbeck, I. and Wahlbeck, K. (2011) Psychosocial interventions for the prevention of depression in older adults: Systematic review and meta-analysis. Journal of Aging and Health[online]. 23 (3), pp.387-416 [Accessed 08 January 2014].Gudex, C., Horsted, C., Jensen, A.M., Kjer, M. and Srensen, J. (2010) Consequences from use of reminiscence-a randomised intervention study in ten Danish nursing homes. BMC Geriatrics [online]. 10 (1),pp.33 [Accessed 12 April 2014].Hatch, D.J. (2013) The Influence of Widowhood and Sociodemographic Moderators on Dementia and Alzheimer's Disease Risk. [online] [Accessed 11 January 2014].Lingler, J.H., Nightingale, M.C., Erlen, J.A., Kane, A.L., Reynolds, C.F.,3rd, Schulz, R. and DeKosky, S.T. (2006) Making sense of mild cognitive impairment: a qualitative exploration of the patient's experience.The Gerontologist [online]. 46 (6), pp.791-800 [Accessed 15 January 2014].Macquarrie, C.R. (2005) Experiences in early stage Alzheimer's disease: understanding the paradox of acceptance and denial. Aging &amp; Mental Health [online]. 9 (5), pp.430-441[Accessed 14 January 2014].McGovern, J. (2012) Couplehood and the Phenomenology of Meaning for Older Couples Living with Dementia [online] [Accessed 20 November 2014].Moher, D., Liberati, A., Tetzlaff, J. and Altman, D.G. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine [online]. 151 (4), pp.264-269 [Accessed 15 January 2014].Moos, I. and Bjorn, A. (2006) Use of the life story in the institutional care of people with dementia: A review of intervention studies. Ageing &amp; Society [online]. 26 (3), pp.431-454 [Accessed 10 December2014].Piiparinen, R. and Whitlatch, C.J. (2011) Existential loss as a determinant to well-being in the dementia caregiving dyad: A conceptual model. Dementia [online]. 10 (2), pp.185-201[Accessed 28 December2013]Sedikides, C., Wildschut, T. and Baden, D. (2004) Conceptual Issues and Existential Functions. Handbook of Experimental Existential Psychology [online]. pp.205 [Accessed 31October 2013].Steeman, E., Casterl, D., Dierckx, B., Godderis, J. and Grypdonck, M. (2006) Living with earlystage dementia: a review of qualitative studies. Journal of Advanced Nursing [online]. 54 (6), pp.722-738[Accessed 17 November 2013].Steeman, E., Tournoy, J., Grypdonck, M., Godderis, J. and DE CASTERL, B.D. (2013) Managing identity in early-stage dementia: maintaining a sense of being valued. Ageing &amp; Society [online]. 33 pp.216-242[Accessed 14 November 2013].Stephens, A., Cheston, R. and Gleeson, K. (2013) An exploration into the relationships people with dementia have with physical objects: an ethnographic study. Dementia (London, England) [online]. 12 (6),pp.697-712 [Accessed 08 October 2013].Van Assche, L., Luyten, P., Bruffaerts, R., Persoons, P., van de Ven, L. and Vandenbulcke, M. (2013) Attachment in old age: Theoretical assumptions, empirical findings and implications for clinical practice.Clinical Psychology Review [online]. 33 (1), pp.67-81[Accessed 12 November 2013].van Tilburg, W.A., Igou, E.R. and Sedikides, C. (2013) In search of meaningfulness: Nostalgia as an antidote to boredom. Emotion [online]. 13 (3), pp.450. [Accessed 10 November 2013].Wang, J., Hsu, Y. and Cheng, S. (2005) The effects of reminiscence in promoting mental health of Taiwanese elderly. International Journal of Nursing Studies [online]. 42 (1), pp.31-36 [Accessed 25 October2013].Wang, J., Yen, M. and OuYang, W. (2009) Group reminiscence intervention in Taiwanese elders with dementia. Archives of Gerontology and Geriatrics [online]. 49 (2), pp.227-232 [Accessed 25 October2014].Woods, B., Spector, A., Jones, C., Orrell, M. and Davies, S. (2005) Reminiscence therapy for dementia. Cochrane Database Syst Rev [online]. 2 [Accessed 25 October 2013].Woods, R.T., Bruce, E., Edwards, R., Elvish, R., Hoare, Z., Hounsome, B., Keady, J., Moniz-Cook, E., Orgeta, V. and Orrell, M. (2012) REMCARE: reminiscence groups for people with dementia and their familycaregiverseffectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technology Assessment [online]. 16 (48), pp.1366-5278 [Accessed 25 October 2013].</p>

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