Journey Through Memories: Reminiscence Therapy for Dementia Care

1. Reminiscence Therapy Sierra Corbin

2. Do you remember…? • https://youtu.be/bnRVheEpJG4 (Charlie bit my finger)

3. Do you remember…?

4. Overview • Understanding RT • Candidates for RT • Our RT Sessions • Lead’s Role • Taking Data • Contacts

5. Reminiscence Therapy (RT): What It Is • “Reminiscence Therapy is the process of recalling personally experienced episodes from one’s past…although reminiscence can be evoked through primarily verbal means, often props such as music, pictures, objects, and sounds are used to facilitate reminiscence.” –(Esther S.K., et al, 2006, p. xxiv) • Can be individual or group

6. Effectiveness of RT • Improved cognition (at follow-up), • Improved mood (at follow-up) • Decreased depression • General behavioral function improved (at the end of the intervention period) • Decrease in caregiver strain • Improved staff knowledge of group members' backgrounds • No harmful effects • Woods, B., Spector, A., Jones, C., Orrell, M., & Davies, S. (2009). Reminiscence therapy for dementia. The Cochrane Database of Systematic Reviews, (2), 1-34. doi:10.1002/14651858.CD001120.pub2. • Stintson, C.K., (2009). Structured group reminiscence: an intervention for older adults. The Journal of Continuing Education in Nursing, 40(9), 521-528.

7. Implementation Requirements • Individuals at a similar level of cognitive-linguistic ability • Small staff to client ratio • Group facilitators should be familiar with cognition and communication in aging and dementia • possess skills in time management, appropriate topics, and group dynamics • Central theme per session, including relevant multi-sensory props/stimuli to serve as retrieval cues • Personally relevant photos and other props to aid in retrieval of memories • Should take place at least weekly. More frequent and/or more sessions may result in stronger effects as suggested by evidence • Kim, E.S., Cleary, S.J., Hopper, T., Bayles, K.A., Mahendra, N., Azuma, T., Rackley, A. (2006). Evidence based practice recommendations for working with individuals with dementia: group reminiscence therapy. Journal of Medical Speech-Language Pathology, 14(3), xxiii- xxxiv.

8. Implementation- Session Requirements • Knowledge of client’s background and experiences • E.g., h/o career, hobbies, war participation, family, religion, and diet textures/consistencies (if providing snacks) • Separate space with limited environmental distractions, including passerby and televisions • Table to sit around and to place objects, large enough for wheelchairs • Large screen with good speakers • Personally relevant items when needed

9. Candidate Requirements Deficits: • Episodic memory (i.e. autobiographical events) impairments as a result of progressive dementia • Mild to moderate dementia severity Abilities: • Attend to and tolerate social interaction within a group without excessive disruption to other group members • Engage in conversation • Functional vision and hearing capabilities to participate in reminiscence therapy activities involving sensory stimuli

10. Clients with Dementia • Cognition: the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses • Language: a systematic means of communicating ideas or feelings by the use of conventionalized signs, sounds, gestures, or marks having understood meanings • Dementia: a usually progressive condition marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior) • Therefore: cognitive-linguistic abilities are effected and are progressive

11. Clients with Dementia • Dementia: Umbrella term • Cognitive changes: • Memory • Communication • Safety awareness • Problem solving/reasoning • Orientation/confusion • Planning ability • Sequencing ability • Task initiation

12. CDS Sessions • Introduction of clinicians, staff, and clients in the first session (using a personal item) • Present the theme • Pass around manipulatives, pictures, scents, and sounds • Story share (ask clients if they have a story to share about the theme/stimuli) • Fun facts (clinicians share fun facts about the theme) and trivia (e.g., “How much did it cost to go to the movies in the 1950s?”) • Music and video with discussion • Simple games (e.g., playing marbles or word to picture matching) • Introduce next session’s theme and obtain client information to plan for next session • Student reflection with supervisor and group

13. Sensory Stimuli • Auditory • Music, sounds (e.g. children playing), old commercials, radio shows, speeches • Olfactory • Strong memory link • Scents related to the theme/topics (e.g., cinnamon sticks for holidays) • Visual • Pictures (e.g., ‘Our American Century’ series or print outs) • Videos • Tactile • Manipulatives (e.g., vintage toys, clothing, cookware) • Gustatory • Tastes related to the theme/topic

14. Sensory Stimuli Example Example Session: • Auditory Stimuli: • Olfactory Stimuli: • Visual Stimuli: • Tactile Stimuli: • Gustatory Stimuli:

15. Lead’s Role • Develop session agenda central to the theme • Bring stimuli • Pick-up and drop-off objects from Treasure’s from the Heart • Facilitate group discussion and smaller conversations • Create opportunity for group sharing by asking individuals questions • Create opportunity for smaller discussions with games (e.g. matching famous people to their name) and connecting clients (“I wonder if Katherine has any suggestions for you?”) • Manage talk times so every person has equal sharing • Attempt to make topics/tasks relevant to client experiences • If clients had a paper route, have them show the group how they folded the paper • If clients played marbles, have them show you how to play (yes, we have them!) • Use 4-5 senses if possible, every session should at least include visuals, manipulatives, and auditory stimuli • Music and video are big hits (encourage choral speaking and singing)

16. Considerations • Have a visual reminder of the session’s theme and any other task • Be thoughtful of seating arrangements • Quite voices, HOH, wheelchair access, distractibility • Encourage client input and creativity (e.g., ask the clients questions ahead of time about your theme) • If clients are sick or unavailable, other residents can join that session • Allow as much access to participation as possible • E.g. If you talk about the pledge of allegiance, play a video of children reciting it and have a HO of the words to assist with recall to say it as a group • If you are not the lead, you are still expected to participate, ask questions, and cue as needed

17. Data • Each student will follow one client throughout the term • Routine Task Inventory (RTI) Communication Scale • Choose the appropriate score after each session for receptive and expressive language • Score due to supervisor • Qualitative Write-up • Client’s cueing needs, response to various stimuli, subjective status • Due to supervisor • MOCA, SLUMS, MMSE, SBT • Initial screening for cognitive-linguistic score

18. Status Write-up Example • Qualitative (Subjective) • “CoSi enjoyed the group setting and interacted with other group members and the CLNs. She demonstrated the ability to participate in the group dynamic and showed interest in the items, especially stimuli that was relevant to her life experiences. She benefitted most from music and tactile stimuli with the clothing. CoSi required moderate cueing to initiate interaction with the objects and moderate cueing, verbal repetition of questions, in order to respond verbally and written cueing (i.e., key words).” • RTI Score (Objective) • CoSi scored a 4 in Comprehension, d/t her need to have questions repeated and needing cueing to respond to others. She scored a 3 in Expression d/t her need for cueing to initiate and short utterances that are relevant to her own experiences.”

19. Manipulatives • Treasures from the Heart • Address: 90034 Prairie Rd, Eugene, OR 97402 • Hours: Thursday-Saturday 12-6 • Pick up Thursday, Friday, or Saturday • Early hours are best, but whenever you are there, she prioritizes customers first • When with you, she can help find or suggest items • There are items (books, objects, and scents) in the materials closet across from Elise’s office • The library and online are resources as well • If you need to buy something, clear it with Sierra so that she can approve and pay for it (e.g., snacks or an item that can be used in other terms)

20. CDS RT Location and Contacts • South Hills Rehab: 1166 E 28th Ave, Eugene, OR, 97403 • Lisa Alsip, Activities Coordinator • Sierra Corbin: 541-301-8901 • Barbara, Treasure’s from the Heart: 541-688-5840