Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis

Kyungsoo Kim; Jia Lee

doi:10.4040/jkan.2019.49.3.225

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Kim and Lee: Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis

Review Article

J Korean Acad Nurs 2019;49(3):225-240.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.3.225

Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis

Kyungsoo Kim, Jia Lee

College of Nursing Science, Kyung Hee University, Seoul, Korea

Address reprint requests to : Lee, Jia College of Nursing Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-961-0894 Fax: +82-2-961-9398 E-mail: leejia@khu.ac.kr

Received 1 November 2018 Revised 22 March 2019 Accepted 2 April 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to evaluate the effects of reminiscence therapy on depressive symptoms in older adults with dementia using a systematic review and meta-analysis.

Methods

Randomized controlled trials (RCTs) published from January 2000 to January 2018 were searched through Research Information Sharing Service (RISS), Korean Studies Information Service System (KISS), Korean Medical Database (KMbase), KoreaMed, PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid MEDLINE. Two researchers independently performed the search, selection, and coding. Comprehensive Meta-Analysis 3.0 was used for meta-analysis, and Review Manager program 5.3 was used for quality assessment.

Results

Out of the 1,250 retrieved articles, 22 RCTs were selected for analysis. The overall effect size of reminiscence therapy for mitigating depressive symptoms in older adults with dementia was -0.62 (95% Cl: -0.92 to -0.31). The effect size was greater in older adults under 80, those with less disease severity, and those for whom the therapy session lasted less than 40 minutes.

Conclusion

Reminiscence therapy is an effective non-pharmacological therapy to improve depressive symptoms in older adults with dementia. Because its effectiveness is also influenced by age, disease severity, and application method, it is necessary to consider treatment designs based on individual characteristics as well as methodological approaches.

Keywords: Mental Recall, Depression, Dementia, Meta-Analysis

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Figure 1.

Flow diagram of study selection.

Figure 2.

Risk of bias and forest plot.

Figure 3.

Funnel plot.

Table 1.

Characteristics of Included Studies

No	Author (yr)	Country	Sample size (n)	Mean age (yr)	Severity of dementia	Interventions				Outcome measurement
No	Author (yr)	Country	Sample size (n)	Mean age (yr)	Severity of dementia	Type for exp.	Type for cont.	No. of times	Length (min)	Outcome measurement
1	Amieva et al.	France	Exp: 170	Exp: 78.8	Mild to	Group	Usual care	15	90	GDS
	(2016)		Con: 170	Con: 78.5	severe	reminiscence
2	Duru Asiret	Turkey	Exp: 31	Exp: 81.8	Mild to	Group	Usual care	12	30∼35	GDS
	et al. (2016)		Con: 31	Con: 82.3	severe	reminiscence
3	Bailey et al.	USA	Exp: 26	Exp: 84.4	Mild to	Group	Usual care	24	30	GDS
	(2017)		Con: 25	Con: 83.9	severe	reminiscence
4	Van Bogaert	Belgium	Exp: 41	Exp: 83	Mild to	Individual	Usual care	4	45	GDS
	et al. (2013)		Con: 41	Con: 85	severe	reminiscence
5	Haight et al	Ireland	Exp: 15	79.5	Mild to	Group	Usual care	8	60	CSDD
	(2006)		Con: 15		severe	reminiscence
6	Hsieh et al.	Taiwan	Exp: 29	Exp: 77.9	Mild to	Group	Usual care	12	45	GDS
	(2010)		Con: 32	Con: 77.3	severe	reminiscence
7	Hsu et al. (2009)	Taiwan	Exp: 21	Exp: 77.9	Mild to	Group	Usual care	6	60	GDS
			Con: 24	Con: 77.9	severe	reminiscence
8	Hutson et al.	UK	Exp: 21	86.6	Mild to	Group	Usual care	14	45	CSDD
	(2014)		Con: 18		severe	reminiscence
9	Karimi et al.	Iran	Exp: 10	70.5	Mild	Group	Active social	6	90	GDS-15
	(2010)		Con: 10			reminiscence	discussion
10	Nakamae et al.	Japan	Exp: 19	Exp: 84.7	Mild to	Group	Usual care	6	40	GDS-15
	(2014)		Con: 19	Con: 87.1	severe	reminiscence in occupational therapy
11	O’Shea et al.	Ireland	Exp: 153	Exp: 85.2	Mild to	Group	Usual care	-	-	CSDD
	(2013)		Con: 151	Con: 85.7	severe	reminiscence
12	Subramaniam	UK	Exp: 12	Exp: 84.5	Mild to	Individual	Usual care	12	60	GDS-12R
	et al. (2013)		Con: 12	Con: 88.3	moderate	reminiscence
13	Van Bogaert	Belgium	Exp: 36	84	Mild to	Individual	Usual care	16	45	CSDD
	et al. (2016)		Con: 36		moderate	reminiscence
14	Wang (2007)	Taiwan	Exp: 51	Exp: 79.7	Mild to	Group	Usual care	8	60	CSDD
			Con: 39	Con: 78.9	severe	reminiscence
15	Yang et al.	Taiwan	Exp: 29	Exp: 78.7	Mild to	Group	Cognitive	8~10	50	CSDDC
	(2016)		Con: 29	Con: 79.1	severe	reminiscence	stimulation
16	Kwon et al.	Korea	Exp: 12	76.9	Mild to	Group	Occupational	18	40	NPI-depression
	(2016)		Con: 12		severe	reminiscence	therapy
						in occupational
						therapy
17	Kim (2015)	Korea	Exp: 7	Exp: 80.9	Mild to	Group	Usual care	14	120	GDS-K
			Con: 7	Con: 85.6	severe	reminiscence
18	Kim et al. (2012)	Korea	Exp: 10	79.2	Mild to	Group	Usual care	16	60	GDS-K
			Con: 10		moderate	reminiscence
19	Lee et al. (2012)	Korea	Exp: 9	78.5	Mild to	Group	Usual care	8	30	KGDS
			Con: 9		moderate	reminiscence
						in occupational
						therapy
20	Jang et al.	Korea	Exp: 10	Exp: 78.8	Mild to	Group	Usual care	8	60	GDS-K
	(2007)		Con: 14	Con: 79.3	moderate	reminiscence
21	Cha (2016)	Korea	Exp: 9	77.0	Mild to	Group	Usual care	8	60	SGDS-K
			Con: 9		severe	reminiscence
						in occupational
						therapy
22	Hong et al.	Korea	Exp: 14	78.9	Mild to	Group	Usual care	12	40	GDS-K
	(2015)		Con: 15		severe	reminiscence
	Total		1,461					227	1,130

Exp.=Experiemntal group; Cont=Control group; CSDD=Cornell Scale for Depression in Dementia; GDS=Geriatric Depression Scale; GDS-K=Geriatric Depression Scale of Korean; KGDS=Korean Form of Geriatric Depression Scale; NPI=Neuropsychiatric Inventory; SGDS-K=Short Form of Geriatric Depression Scale Korean Version.

Table 2.

Effect Size and Tendency by Variables

Total effect size

N	Q		p	I²		Effect size	SE	95% CI

22	138.57	<.001	84.85		-0.62		0.15	-0.92~-0.31

Effect size by variables

Variables	Categories		N	Effect size		p	95% CI

By age (yr)	≤80		14	-0.83		<.001	-1.24~-0.42
	≥81		8	-0.31		.244	-0.81~0.20
By severity	Mild		6	-0.77		.013	-1.38~-0.16
	Severe		16	-0.57		.001	-0.91~-0.22
By type of intervention	Group		19	-0.67		<.001	-1.00~-0.36
	Individual		3	-0.34		.407	-1.14~0.46
By length of intervention (min)	<40		3	-1.07		.007	-1.85~-0.30
	40~<50		7	-0.77		.003	-1.27~-0.27
	50~<60		1	-0.50		.433	-1.73~0.74
	60~<70		8	-0.29		.227	-0.76~0.18
	90~<100		1	-1.26		.096	-2.75~0.22
	≥100		1	-2.49		.007	-4.29~-0.69
By number of times	≤8		9	-0.74		.004	-1.24~-0.24
	9~18		11	-0.66		.004	-1.11~-0.21
	≥19		1	-0.39		.599	-1.81~1.03

Tendency by variables

Variables	Coefficient		SE	Lowest	Highest	Z	p	T²

By age	Intercept	-1.49	-2.94	0.51	-0.50	-2.49	.011	0.69
	Slope	0.67	0.34	-0.01	1.35	1.97	.222
By number of times	Intercept	-0.89	0.40	-1.66	-0.11	-2.24	.025	0.69
	Slope	-0.02	0.03	-0.04	0.08	0.59	.558
By length of intervention (min)	Intercept	-0.72	0.44	-1.58	0.15	-1.61	.107	0.36
	Slope	0.01	0.01	-0.01	0.02	0.11	.909

SE=standard error; CI=confidence interval.

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