The Power of Reminiscence in Helping Older Adults with Depression

Published In Mental Health & Well-Being

November 10th, 2015

One of the things I’ve heard said (and I often jokingly say myself) is that having children is a convenient excuse for getting to have a second childhood, to relive one’s youth. This was most definitely a phenomenon that came true for me this most recent Halloween Eve. I had been invited to my significant other’s Halloween “trunk or treat” at her daughter’s school that evening, which was a very noisy, lively, costumed and candy-filled affair. The theme of the event was that parents were invited to decorate the tailgates of their cars in as lavish and creative a Halloween theme as possible, and serve up candy (of course) from the trunks of their cars – hence the “trunk” in “trunk or treat.”

Anyways, there was also music playing at the event, which included songs from the classic, designed-to-be-so-bad-it’s-actually-good “Rocky Horror Picture Show,” classics like “The Monster Mash” and the theme from “The Munsters,” and as a finale, the guests at the party were treated to a fully choreographed re-creation of the inimitable classic, Michael Jackson’s “Thriller.”

I am 42 years old – not exactly an older adult. (Although as an aside – our medical director, whom I’ve worked with for the last eight years, informed me recently I am now “middle aged,” which I initially received with the typical knee-jerk glum reaction you’d expect from an American raised on a steady diet of ageist cultural messaging.) Yet, as I wandered through the party with my significant other and her daughter, seeing the costumes ranging from the cute to horrifying to surprisingly creative, and hearing all of these songs I had heard from a number of years ago, I found myself suddenly awash with nostalgia, recalling the time I first watched the “Thriller” video. Recalling my favorite horror movie. Recalling what it was like to go out trick-or-treating with friends, or, when I was older, causing probably some unwise mischief in the neighborhood as a mildly wayward young teenager. I was reminiscing, surfing waves of memories from my past, connecting the events around me that night with positive (or at least, very pleasurable and stimulating) memories from my past.

Reminiscence as a Path to Reclaiming One’s Sense of Self

The term reminiscence simply is defined as a “pleasurable recollection of past events.” When you think about it (and in some ways, bridging from my discussion in one of my previous articles about pleasant events), reminiscence is an almost critically important way that older adults keep connected to their sense of self. As a younger adult, my hopes, aspirations and dreams were my sense of self – sure, I could look backward and reminisce to some limited degree, but the things that connected me with who I was were all about what I saw when I looked forward – graduate school, a successful career, a stable and satisfying relationship, home, and children.

Now think about an older adult, someone in their 70s and beyond – really, for the most part, they’ve lived well beyond more than half of their life expectancy. They may have some further hopes, dreams, and aspirations, to be sure (after all, I always get a kick out of the occasional stories I hear about older adults finding love and marriage for the first time as older people, or finally earning their bachelors or doctoral degrees, etc.), but really, when you come right down to it – the things that connect older adults with their sense of self and being are the things they see when they are looking backward. This, by the way, why older adults, when properly valued, are looked at (rightfully so!) as repositories of wisdom and experience. They have lived lives and learned lessons, they have stories to tell!

Moreover, reminiscence has some great advantages as a mode of interaction with older adults with serious memory problems or dementia. While a given cognitively impaired older adult may not, for example, be able to engage you in a cogent or productive discussion about a TV program they just watched, they will be much more likely to be able to recall in stark detail the guest list at their daughter’s wedding years ago, what the groom wore, what they served at the event, etc.

The Antidepressant Effect of Reminiscence in Older Adults

Nursing staff and other clinical disciplines who work with older adults (cognitively intact or otherwise) are trained to engage with their geriatric patients in a manner that incorporates reminiscence. It may also be considered a bona-fide form of therapeutic intervention with older adults. Depending on how skillfully clinicians are trained to engage a patient, reminiscence therapy can help a patient better reconnect with past instances of positive coping, such as in the case of so-called instrumental reminiscence therapy, or by helping a patient disconfirm dysfunctional views of themselves via integrative reminiscence therapy.

In my work with patients, I’ve tended to use something more approximating the instrumental approach when I’ve engaged my long-term-care residents in a reminiscence exercise, often by engaging a depressed resident in a discussion of what they enjoyed about their previous careers (as homemakers or in their vocation, etc). Interestingly, even if it’s a job or career that a person has had to long ago give up (which may in part be related to the older adults mental health problems with depression, for example – mourning the loss of their role identity), I’ve found that almost without fail, older adults who have led fulfilling careers inside and outside the home will almost reliably perk up and begin showing signs of positive mood shift in-session with an engaged and energetic guided reminiscence.

For some, it may seem counterintuitive that it brings a positive shift in mood to older adults when you engage them in a discussion of a treasured role that they have had to leave behind. Basically, shouldn’t that depress them more, to bring up memories of things they can’t do anymore?

The short answer is “no.” In my work as a long-term-care geropsychologist, one of the things that’s easily observable in my patients who present with late-life depression (often being depressed for the first times in their lives) is that they have lost their sense of self. In the everyday lives they have now, they are no longer closely linked to their previous careers as housewives, father, mother, businessman, professional, etc. So, engaging them in this form or reminiscence is a powerful way to reconnect them with who they are.

The interesting thing about reminiscence, and what I experienced first-hand at the “trunk or treat” event, above, is how truly energizing and pleasurable this experience of reconnecting with one’s past actually is! Positive reminiscence can serve as a powerful pleasant event for older adult patients (or for middle aged geropsychologists like myself, even!). This may be why “reminiscence groups” are often utilized by long-term care activity and clinical staff for nursing home patients. Depending on the cultural and chronological homogeneity of the group (e.g., similar ages and similar cultural backgrounds work best), one can engineer a very pleasurable experience for older adult patients by simply gathering patients together and leading a discussion about favorite types of classic cars (which can lead to potentially very lively discussions about drive-in-movie experiences, first kisses, ‘hot-rodding,’ etc.), favorite Sinatra movies, and the like. In fact, I would venture that this pleasurable quality associated with many types of reminiscence are what forms the basis for many of the positive clinical effects of complementary and alternative medicine approaches like aromatherapy, music therapy, and perhaps even therapeutic approaches like animal-assisted interventions.

Smells, music – both are well-known to be highly evocative. For my Halloween “trunk or treat” experience, in fact, it was the music that really transported me back. In terms of the positive effects of aromatherapy (which is an alternative medicine approach based on exposing patients to essential oils from natural plant sources, such as lavender or peppermint), the deeply evocative quality of the olfactory (smelling) sense has long been recognized. In fact, it has been posited by some as being due to our olfactory nervous system being so closely linked to our limbic system, one of the most evolutionarily old parts of our brain.

Reminiscence Therapy and Medicare

One final interesting note about reminiscence therapy, that relates back to one of my old standby pet peeves – Medicare – which, for my community nursing home practice colleagues (the psychologists who toil away doing fee-for-service direct care in nursing homes) is the bread and butter of their practices – but also has been doling out increasingly meager reimbursements over the years. Reminiscence therapy, despite how positive and powerful of a therapeutic effect it may yield – is not reimbursable under Medicare, at least not by mental health professionals. The reason being – it’s allegedly something anyone can do with a patient. While that may be true, I’m not sure that it’s something anyone can skillfully do. Likewise, of course, aromatherapy, animal-assisted interventions, and music therapy are likewise not (as far as I’m aware), reimbursable under Medicare.

What is reimbursable is something called life review therapy, which is basically a highly structured reminiscence technique – e.g., it requires training to administer – and is also validated as an effective treatment with older adults. Because it requires specialized training, this is one of the only reminiscence-based (or reminiscence-friendly, like aromatherapy or music) techniques that Medicare will actually pay for.

For your part, as a caregiver – just know that one of the most healing and personally satisfying (for you as well as them!) things you can do with your older adult client or loved one is to fearlessly engage them in the process of looking back at their lives and evaluating, celebrating, and enjoying what makes them special.

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