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 and loneliness can have a significant impact on health and quality of life,2 with health risks comparable to traditional clinical risk factors, such as smoking, obesity, high blood pressure, and high cholesterol.4 Prolonged isolation has been estimated by the AARP to be equivalent to smoking 15 cigarettes a day,5 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,6,7 cognitive decline and mental health conditions such as depression and dementia,8,9 increased numbers of falls,10 increased emergency department admissions,11 longer hospital stays and delayed discharges,12 increased drinking13 and smoking,14 sedentary lifestyle,15 and poor nutrition.16 Unfortunately, there are no interventions that have been shown to be effective in reducing social isolation or loneliness on a large scale.17
Alzheimer’s Disease and Dementia
There are more than 5 million Americans suffering from Alzheimer’s disease (AD) and related dementias.18 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 $259 billion in 2017.19 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.20
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.21 For this reason, there has been a renewed focus on non-pharmaceutical approaches that can target mood and physiological distress, rather than on pharmaceutical 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.22 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.17
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.23-26 Specifically, RT has been found to decrease depressive emotions27-29 and feeling of loneliness,30 and to increase psychological well-being,27,28,31 life satisfaction,26,27,32-39 and communication.29 In addition, RT was found to increase cognitive level30,40 and social activities,41 and have a positive effect on activities of daily living.39 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.42
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.
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.
 Federal Interagency Forum on Aging Related Statistics. New Federal Report Released on Older Americans. August 2, 2016. https://agingstats.gov/news.html
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