Reminiscence therapy is the most widely used among non-drug treatments for dementia in Japan. However, since it is a type of complementary and alternative therapy, nurses generally don't have much knowledge and there are few researches. Especially there aren’t many researches on individual reminiscence therapy.
Therefore, in this research, we intend to clarify the pictures of conversation evoking to reminiscence of dementia elderly and to get the suggestions about how to talk with dementia elderly to urge effective reminiscence in nursing care.
Methods:
We conducted the reminiscence for 4 older adults with dementia, and researchers with the consents of themselves and their families, and recorded conversation and NIRS (Near Infrared Spectroscopy) data.
Researchers visited the facility to perform individual reminiscence, twice a week, for about 20 minutes, for a month.
The items we used during reminiscence were; the software "Personal computer reminiscence therapy (N. Progress Co.)" to reproduce old scenery and events with illustration and sound, and the photo album "Photo reminiscence method in the Showa era (Rural Culture Association Japan)", Beanbag and Menko, Japanese children's toy.
As the first step, we excluded the data that older adults with dementia answered only "yes" or "no" when the researcher talked to them, and as the second stage, we examined the parts of the elderlies’ actively conversations that they remembered about old memories.
The recorded conversation data were converted to text data.
Changes in blood flow of frontal lobe were measured by the NIRS. The set of optical encephalography (Spectratech, Inc., OEG-16) was used to measure it. This device is noninvasive and can measure the activity of the frontal lobe.
This research got the approval of the Ethical Review Board of the university where a primary researcher belonged to. We explain in writing and verbally that research aims, methods, research cooperation are arbitrary, that there is no disadvantage of participation refusal, that the withdrawal of study participants is also possible, to protect the privacy. It was performed on with the consent.
Results:
1.Participants
4 older adults living in a nursing home participated (The degree of dementia is mild and moderate for 2 patients each, average age 91.5 years).
2.Text data
In case of A (mild dementia, male), the activation was found in his conversation at the time of reminiscence of Menko, picture-card show and agriculture. He talked about agriculture in combination such as agricultural machinery and cattle, and the strict mother. When he talked about his mother, he was sometimes joking.
B (mild dementia, female) had the actively of the conversation during the reminiscence of washing, beanbags, and her own business. Regarding the place of birth, she told the name of the place and of the temple.
From C (moderate dementia, male), with only "yes" or "no" reactions, there was no sign that leads to activation of the conversation by reminiscence. In his session, he sang the songs of old times and reacted well. He mentioned his place of birth, but it did not lead to reminiscence.
In the case of D (moderate dementia, female), we found the activation of the conversation, in the reminiscence of the topics of her school days. We found her jokes when she talked about the story that she had been to the night stalls of a local festival.
3.NIRS data
Concerning ΔOxy-Hb, all values of participants were higher for the activated conversation than usual. In particular, the values of the scene that they made a joke were high.
Conclusion:
It was confirmed that the reminiscence stimulates frontal lobe activation. This finding that the reminiscence is an effective method for older adults with dementia.
Also, even when using the same reminiscence material, there was individuality in the signal to activate each reminiscence.
In conversation with older adults with dementia, there should be the necessity to grasp the features about the details of the actively of the conversation.
However, using tools that stimulate recollection, that there is the possibility we can approach them without knowing their life history.
In this research, we could feel strongly the need of individual reminiscence because there is the possibility that reminiscence might not be reached deep enough by group reminiscence therapy when it should not fit the individual's experience.
From this point we might go on to an even more detailed examination.
This research was based on the research data supported by JSPS Grants-in-aid for Scientific Research 24593544, and conducted at Setsunan University where a primary researcher once belonged to. About this time, we receiving research scholarships from Mukogawa Women's University, and we conducted additional analysis.