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) and related dementias [19]. 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, but they have shown only moderate and short-term benefits on a limited number of symptoms [1]. Most high-profile Alzheimer’s drugs under development have had disappointing results, leading some of these companies to abandon Alzheimer’s research altogether [23].

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 [20]. 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 [20].”

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], communication [38], interaction [37,39], quality of life [38], life satisfaction [37,29,33], well-being [26,30,33,34,40-42], self-esteem [37,29,33], activities of daily living [37], 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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