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Reminiscence Therapy in Social Isolation and Dementia

 

Social isolation and Loneliness 

The U.S. population is rapidly aging, with 21% of the population, or 74 million people, expected to be older than 65 by 2030 [1]. Social isolation is estimated to impact up to 50% of seniors, and loneliness has been shown to affect approximately one-third of adults later in life [2,3]. Social isolation in older adults is estimated to be associated with $6.7 billion in added Medicare spending annually [4].

Social isolation and loneliness can have a significant impact on health and quality of life [2], with health risks comparable to smoking, obesity, high blood pressure, and high cholesterol [5]. Prolonged isolation has been estimated by the AARP to be equivalent to smoking 15 cigarettes a day [6], and in another study it was shown to increase the likelihood of mortality by more than 25% [3].

Social isolation in older adults has been associated with decreased resistance to infection [7,8], cognitive decline and mental health conditions such as depression and dementia [9,10], increased numbers of falls [11], increased emergency department admissions [12], longer hospital stays and delayed discharges [13], increased drinking [14] and smoking [15], sedentary lifestyle [16], and poor nutrition [17]. Unfortunately, there are no interventions that have been shown to be effective in reducing social isolation or loneliness on a large scale [18].

Alzheimer’s Disease and Dementia

There are more than 5 million Americans suffering from Alzheimer’s disease (AD)

There are more than 5 million Americans suffering from Alzheimer’s disease (AD) and related dementias [20]. The cost of care for dementia patients is expected to quadruple from $277 billion in 2018 to more than $1.1 trillion in 2050 [20]. Dementia is also a growing problem for the military, and veterans with traumatic brain injury (TBI) in particular have been shown to have an increased risk of developing dementia [21].

According to the Alzheimer’s Association, Alzheimer’s dementia “is the only top 10 cause of death that cannot be prevented, cured or even slowed [20].” There are currently four drugs that are FDA approved to treat the symptoms of Alzheimer’s disease, rather than the disease itself [47-50]. However, they have shown only moderate and short-term benefits on a limited number of symptoms [20, 51-55]. Most high-profile Alzheimer’s drugs under development have had disappointing results, leading some of these companies to abandon Alzheimer’s research altogether [23, 56-59].

For these reasons, organizations such as the Alzheimer’s Association and National Institute of Aging have been increasingly focusing on non-pharmacological approaches that can target mood and physiological distress, rather than on pharmacological approaches that slow the progression of cognitive deficits [60]. The Alzheimer’s Association specifically states that “non-pharmacologic approaches should be tried as a first-line alternative to pharmacologic therapy for the treatment of behavioral and psychotic symptoms of dementia [61].”

Reminiscence Therapy

Reminiscence Therapy (RT) is a behavioral intervention that involves the introduction of familiar pictures, music, or other materials to help individuals reminisce about their past experiences. RT is the most commonly used non-pharmacological therapy in Alzheimer’s and other types of dementia, and has been used since the 1960s in home care and in the nursing home and hospital settings [24]. RT is also the only intervention that was shown to be effective in reducing loneliness in seniors in a recent systematic review of more than 400 studies of social isolation [17].

RT has been shown in clinical studies to have a positive impact on mood and cognitive performance in individuals with Alzheimer’s or other dementias, as well as in older adults with social isolation [25-28]. Specifically, RT has been found to reduce depression [25-36], apathy [27], and loneliness [30,36] while improving cognitive performance [25,34,37], behavioral functioning [28], mood [37, 62], communication [38], interaction [38,39], quality of life [39], life satisfaction [29,33,37], well-being [26,30,33,34,40-42], self-esteem [29,33,37], activities of daily living [38], and social activities [43]. A recent meta-analysis of 12 randomized controlled studies demonstrated that RT significantly improved cognitive function and reduced depression in dementia, and concluded that RT should be considered as routine care for those with dementia, particularly for patients in memory care facilities [44]. A recent systematic review of the literature concluded that RT has the potential to improve quality of life, cogitative function, communication, and mood, but also stated that the literature is hard to compare because the methods of delivery of RT have been highly variable [45].

The “continuity theory” is most widely believed to be the theoretical basis for the success of RT:

“The elderly use the familiar knowledge, skills, and strategies to develop stable patterns of activity and adapt to aging. Remote memory, within which reminiscence processes occur, is usually the last system to deteriorate in the elderly. Increased use of remote memory in older adults improves general cognitive function [37].”

 A major limitation of RT is that it must be provided physically by a human caregiver. For this reason, it is highly labor-intensive, repetitive, and time-consuming.  It is simply not practical for a family caregiver to sit with a dementia patient to go over the same photo scrapbook, home videos, or music on a daily basis, and using a therapist or professional caregiver for frequent RT is cost prohibitive. A tool that can enable RT to be provided frequently, consistently, and without the need to depend on family members or healthcare providers has the potential to significantly increase the impact of RT.

  

The ReminX Solution

ReminX is a digital therapeutic that allows Reminiscence Therapy to be personalized and delivered directly to seniors without the structured time requirement or one-on-one administration that is needed with traditional RT. The goal is to scale RT such that it can become a practical and accessible adjunct behavioral intervention for seniors experiencing social isolation and loneliness as well as those with Alzheimer’s and other dementias. ReminX also is intended to assist the family caregiver, by enabling them to care of their loved one remotely and to enroll other friends and family in care.

A recent clinical pilot study was performed in collaboration with UC San Diego to determine whether ReminX could be used to deliver RT in the home setting [46]. Results indicated that subjects with dementia reported significantly less anxiety, depression, and overall emotional distress after having viewed their customized stories. Furthermore, caregivers also reported that their loved one appeared less emotionally distressed. In addition, the accessibility and ease of use of the software system suggests that this technology holds great promise for bringing important aspects of reminiscence therapy to patients with dementia who are suffering from various mood symptoms.


 

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References

 [[1]] Federal Interagency Forum on Aging Related Statistics. New Federal Report Released on Older Americans. August 2, 2016. https://agingstats.gov/news.html

[2] Landeiro F, Barrows P, Musson EN, Gray AM, Leal J. Reducing social isolation and loneliness in older people: a systematic review protocol. BMJ open. 2017 May 1;7(5):e013778.

[3] Holt-Lunstad J, Smith T, Layton B. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316

[4] Flowers L, Houser A, Noel-Miller C, Shaw J, Bhattacharya J, Shoemaker L, Farid M. Medicare spends more on socially isolated older adults. AARP Public Policy Institute. November 2017. https://www.aarp.org/content/dam/aarp/ppi/2017/10/medicare-spends-more-on-socially-isolated-older-adults.pdf

[5] Pantell M, Rehkopf D, Jutte D, Syme SL, Balmes J, Adler N. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. American journal of public health. 2013 Nov;103(11):2056-62.

[6] AARP. Connect2affect. What is isolation? https://connect2affect.org/about-isolation/

[7] Cohen S, Doyle WJ, Skoner DP, et al. Social ties and susceptibility to the common cold. JAMA 1997;277:1940–4.

[8] Cornwell EY, Waite LJ, Disconnectedness S. Perceived isolation, and Health among Older adults.. Journal of Health and Social Behavior 2009;50:31–48.

[9] Cacioppo JT, Hawkley LC, Norman GJ, et al. Social isolation. Ann N Y Acad Sci 2011;1231:17–22.

[10] Béland F, Zunzunegui MV, Alvarado B, Otero A, del Ser T. Trajectories of cognitive decline and social relations. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2005 Nov 1;60(6):P320-30.

[11] Faulkner KA, Cauley JA, Zmuda JM, Griffin JM, Nevitt MC. Is social integration associated with the risk of falling in older community-dwelling women?. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2003 Oct 1;58(10):M954-9.

[12] Hastings SN, George LK, Fillenbaum GG, et al. Does lack of social support lead to more ED visits for older adults? Am J Emerg Med 2008;26:454–61.

[13] Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int 2016;27:737–45.

[14] Hanson, B. S. (1994). Social network, social support and heavy drinking in elderly men-a population study of men born in 1914, Malmo, Sweden. Addiction, 89, 725–732.

[15] Nicholson NR. A review of social isolation: an important but underassessed condition in older adults. The journal of primary prevention. 2012 Jun 1;33(2-3):137-52.

[16] Eng PM, Rimm EB, Fitzmaurice G, Kawachi I. Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men. American journal of epidemiology. 2002 Apr 15;155(8):700-9.

[17] Locher JL, Ritchie CS, Roth DL, Baker PS, Bodner EV, Allman RM. Social isolation, support, and capital and nutritional risk in an older sample: ethnic and gender differences. Social Science & Medicine. 2005 Feb 1;60(4):747-61.

[18] Franck L, Molyneux N, Parkinson L. Systematic review of interventions addressing social isolation and depression in aged care clients. Quality of Life Research. 2016 Jun 1;25(6):1395-407.

[19] Hillis K. Brain Test. Dementia Statistics – U.S. & Worldwide Stats. https://braintest.com/dementia-stats-u-s-worldwide/

[20] Alzheimer's Association. 2018 Alzheimer's disease facts and figures. Alzheimers Dement 2018;14(3):367-429.

[21] Barnes DE, Kaup A, Kirby KA, Byers AL, Diaz-Arrastia R, Yaffe K. Traumatic brain injury and risk of dementia in older veterans. Neurology. 2014 Jul 22;83(4):312-9.

[22] WebMD. What Medicines Treat Dementia? https://www.webmd.com/alzheimers/guide/medicines-to-treat-dementia

[23] Ogg JC, The list of failed Alzheimer’s drug treatments keeps growing. 24/7 Wall St.. September 26, 2017. http://247wallst.com/healthcare-business/2017/09/26/the-list-of-failed-alzheimers-drug-treatments-keeps-growing/

[24] Kupucu, Duru Aşiret. The use of Reminiscence Therapy in Alzheimer Patients. J Neurology & Stroke. 6(2). 2017.

[25] Duru Aşiret, G., & Kapucu, S. (2016). The effect of reminiscence therapy on cognition, depression, and activities of daily living for patients with Alzheimer disease. Journal of Geriatric Psychiatry and Neurology29(1), 31-37. 

[26] Gonzalez, J., Mayordomo, T., Torres, M., Sales, A., & Meléndez, J. C. (2015). Reminiscence and dementia: a therapeutic intervention. International Psychogeriatrics, 27(10), 1731-1737.

[27] Hsieh, C. J., Chang, C., Su, S. F., Hsiao, Y. L., Shih, Y. W., Han, W. H., & Lin, C. C. (2010). Reminiscence group therapy on depression and apathy in nursing home residents with mild-to-moderate dementia. Journal of Experimental & Clinical Medicine, 2(2), 72-78.

[28] Hsu YC, Wang JJ. Physical, affective, and behavioral effects of group reminiscence on depressed institutionalized elders in Taiwan. Nursing research. 2009 Jul 1;58(4):294-9.

[29] Chao SY, Liu HY, Wu CY, Jin SF, Chu TL, et al. (2006) The effects of group reminiscence therapy on depression, self esteem, and lifesatisfaction on elderly nursing home residents. J Nurs Res 14(1): 36-44.

[30] Chiang KJ, Chu H, Chang HJ, Chung MH, Chen CH, et al. (2010) The effects of reminiscence therapy on psychological well-being, depression, and loneliness among the institutionalized aged. Int J Geriatr Psychiatry 25(4): 380-388.

[31] Chueh KH, Chang TY (2014) Effectiveness of group reminiscence therapy for depressive symptoms in male veterans: 6 month followup. Int J Geriatr Psychiatry 29(4): 377-383.

[32] Stinson CK, Kirk E. Structured reminiscence: an intervention to decrease depression and increase self‐transcendence in older women. Journal of clinical nursing. 2006 Feb 1;15(2):208-18.

[33] Meléndez-Moral JC, Charco-Ruiz L, Mayordomo-Rodríguez T, Sales-Galán A (2013) Effects of a reminiscence program among institutionalized elderly adults. Psicothema 25(3): 319-323.

[34] Van Bogaert P, Van Grinsven R, Tolson D, Wouters K, Engelborghs S, et al. (2013) Effects of SolCos model-based individual reminiscence on older adults with mild to moderate dementia due to Alzheimer disease: a pilot study. J Am Med Dir Assoc 14(7): 528.e9-e13.

[35] Youssef FA (1990) The impact of group reminiscence counseling on a depressed elderly population. Nurse Pract 15(4): 32-38.

[36] Franck L, Molyneux N, Parkinson L. Systematic review of interventions addressing social isolation and depression in aged care clients. Quality of Life Research. 2016 Jun 1;25(6):1395-407.

[37] Lin YC, Dai YT, Hwang SL (2003) Reminiscence effect for elderly. Public Health Nurs 20(4): 297-306.

[38] Thorgrimsen L, Schweitzer P, Orrell M. Evaluating reminiscence for people with dementia: a pilot study. The Arts in Psychotherapy. 2002 Apr 1;29(2):93-7.

[39] Serrani Azcurra DJ. A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease: a randomized controlled trial. Revista Brasileira de Psiquiatria. 2012 Dec;34(4):422-33.

[40] Burnside I, Haight BK (1992) Reminiscence and life review: analyzing each concept. J Adv Nurs 17(7): 855-862.

[41] Lai CK, Chi I, Kayser-Jones J. A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia. International Psychogeriatrics. 2004 Mar;16(1):33-49.

[42] Stinson KC (2009) Structured group reminiscence: an intervention for older adults. J Contin Educ Nurs 40(11): 521-528.

[43] Siviş R, Demir A. The efficacy of reminiscence therapy on the life satisfaction of Turkish older adults: A preliminary study. Turkish Journal of Geriatrics. 2007;10(3):131-7.

[44] Huang HC, Chen YT, Chen PY, Hu SH, Liu F, Kuo YL, Chiu HY. Reminiscence therapy improves cognitive functions and reduces depressive symptoms in elderly people with dementia: a meta-analysis of randomized controlled trials. Journal of the American Medical Directors Association. 2015 Dec 1;16(12):1087-94.

[45] Woods B, O'Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews 2018, Issue 3.

[46] Filoteo JV, Cox EM, Split M, Gross M, Culjat M, Keene D. Evaluation of ReminX as a behavioral Intervention for mild to moderate dementia. In Proceedings 40th International IEEE Engineering in Medicine and Biology Conference. 2018. Honolulu, HI. 17-21 July 2018. Paper FrBT19.1

[47] APRICEPT ODT (donepezil hydrocholoride) Drug Label. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/021720_S000_Aricept_PRNTLbL.pdf

[48] EXELON (rivastigmine tartrate) Drug Label. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2000/20823_Exelon_prntlbl.pdf

[49] RAZADYNE (galamantine hydrobromide) Drug Label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021169Orig1s032,021224Orig1s030,021615Orig1s023lbl.pdf

[50] FDA. NAMENDA (memantine HCl) Drug Label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021487s010s012s014,021627s008lbl.pdf

[51] Trinh NH, Hoblyn J, Mohanty S, Yaffe K. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis. Jama. 2003 Jan 8;289(2):210-6.

[52] Rodda J, Morgan S, Walker Z. Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. International psychogeriatrics. 2009 Oct;21(5):813-24.

[53] Rozzini L, Costardi D, Chilovi BV, Franzoni S, Trabucchi M, Padovani A. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. International journal of geriatric psychiatry. 2007 Apr 1;22(4):356-60.

 [54] Schneider LS, Dagerman KS, Higgins JPT, McShane R. Lack of Evidence for the Efficacy of Memantine in Mild Alzheimer Disease. Arch Neurol. 2011;68(8):991–998. doi:10.1001/archneurol.2011.69

[55] Fox C, Crugel M, Maidment I, et al. Efficacy of Memantine for Agitation in Alzheimer’s Dementia: A Randomised Double-Blind Placebo Controlled Trial. Breitner JCS, ed. PLoS ONE. 2012;7(5):e35185. doi:10.1371/journal.pone.0035185.

[56] Pfizer ends research for new Alzheimer's, Parkinson's drugs. Reuters Health News. January 7, 2018. https://www.reuters.com/article/us-pfizer-alzheimers/pfizer-ends-research-for-new-alzheimers-parkinsons-drugs-idUSKBN1EW0TN

[57] Reuters. Johnson & Johnson scraps Alzheimer's trials on safety concerns. Reuters HEALTH NEWSMAY 18, 2018. https://www.reuters.com/article/us-johnson-johnson-study-alzheimers/johnson-johnson-scraps-alzheimers-trials-on-safety-concerns-idUSKCN1IJ2BC

[58] vTv Therapeutics Announces Topline Results from Part B of Phase 3 STEADFAST Study. Yahoo Finance. June 12, 2018. https://finance.yahoo.com/news/vtv-therapeutics-announces-topline-results-203000477.html

[59] Rana P, Loftus P. Eli Lilly, AstraZeneca Drop Two Late-Stage Alzheimer’s Drug Trials. Wall Street Journal. June 12, 2018. https://www.wsj.com/articles/eli-lilly-astrazeneca-drop-two-late-stage-alzheimers-drug-trials-1528797681

[60] Reus VI, Fochtmann LJ, Eyler AE, Hilty DM, Horvitz-Lennon M, Jibson MD, Lopez OL, Mahoney J, Pasic J, Tan ZS, Wills CD. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. American Journal of Psychiatry. 2016 Apr 22;173(5):543-6.

[61] Alzheimer's Association. Statement Regarding the Treatment of Behavioral and Psychiatric Symptoms of Alzheimer's Disease. https://www.alz.org/national/documents/statements_antipsychotics.pdf

[62] Meeks S. Alzheimer’s Association 2018 Dementia Care Practice Recommendations. https://www.alz.org/getmedia/1a0020aa-0bfb-47ac-a545-1dd8a3ee1444/alzheimers-dementia-care-practice-recommendations