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.1,2 Social isolation in older adults is estimated to be associated with $6.7 billion in added Medicare spending annually.1
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.1 Prolonged isolation has been estimated by the AARP to be equivalent to smoking 15 cigarettes a day,1 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,1,2 cognitive decline and mental health conditions such as depression and dementia,1,2 increased numbers of falls,1 increased emergency department admissions,1 longer hospital stays and delayed discharges,13 increased drinking14 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 Of the 1.4 million people in nursing homes and 700,000 in residential care communities, about 50% suffer from some form of dementia. The costs to the U.S. in caring for patients with AD and other dementias will be approximately $277 billion in 2017.20 The number of individuals with AD is expected to triple by the year 2050, and the cost of patient care will also likely triple to $708 billion annually. 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
The cognitive deficits and behavioral symptoms (e.g., depression, anxiety, and apathy) are difficult to treat in AD and other forms of dementia. Currently the first-line of treatment for AD are pharmaceuticals, but these have met with only limited success, with many high-profile AD drugs having disappointing results.22 For this reason, 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.
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 AD and other types of dementia, and has been used since the 1960s for home care and in the nursing home and hospital settings.23 Group 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.18
RT has been shown to have a positive impact on mood and cognition in such populations as individuals with AD or other dementias, as well as in older adults with depression, anxiety, and social isolation.24-27 Specifically, RT has been found to decrease depressive emotions28-30 and feeling of loneliness,31 and to increase psychological well-being,29,30,32 life satisfaction,28,29,33-40 and communication.31 In addition, RT was found to increase cognitive level32,41 and social activities,42 and have a positive effect on activities of daily living.41 A recent meta-analysis of 12 randomized controlled studies demonstrated that RT significantly reduced depression and concluded that RT should be considered as routine care for those with dementia, particularly for dementia patients in memory care facilities.43
Major limitations of this therapy, however, are that it is highly labor-intensive, is typically provided in a formal group therapy session, is only provided once a week, and is only provided within a limited time-frame, which greatly limits the consistent use of RT. One-on-one RT is generally most effective, but can be very time consuming for the caregiver and is not practical in most settings. Although digital RT technologies are now under development that may facilitate delivery of RT to individual patients, none are scalable and none have yet been widely adopted.
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. 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.
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 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/
23 Kupucu, Duru Aşiret. The use of Reminiscence Therapy in Alzheimer Patients. J Neurology & Stroke. 6(2). 2017.
24 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 Neurology, 29(1), 31-37.
25 Gonzalez, J., Mayordomo, T., Torres, M., Sales, A., & Meléndez, J. C. (2015). Reminiscence and dementia: a therapeutic intervention. International Psychogeriatrics, 27(10), 1731-1737.
26 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.
27 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.
28 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.
29 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.
30 Zauszniewski JA, Eggenschwiler K, Preechawong S, Roberts BL, Morris DL (2006) Effects of teaching resourcefulness skills to elders. Aging Ment Health 10(4): 404-412.
31 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.
32 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.
33 Lin YC, Dai YT, Hwang SL (2003) Reminiscence effect for elderly. Public Health Nurs 20(4): 297-306.
34 Burnside I, Haight BK (1992) Reminiscence and life review: analyzing each concept. J Adv Nurs 17(7): 855-862.
35 Stinson KC (2009) Structured group reminiscence: an intervention for older adults. J Contin Educ Nurs 40(11): 521-528.
36 Youssef FA (1990) The impact of group reminiscence counseling on a depressed elderly population. Nurse Pract 15(4): 32-38.
37 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.
38 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.
39 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.
40 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.
41 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.
42 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.
43 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.