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  • The Comparative Effectiveness Among Institutionalized

    and Non-Institutionalized Elderly People

    in Taiwan of Reminiscence Therapy

    as a Psychological Measure

    Jing-Jy Wang

    ABSTRACT: This study examined the comparative effects of reminiscence on self-esteem, self-health perception,

    depressive symptoms, and mood status of elderly people residing in long-term care facilities and at

    home. A quasi-experimental design was conducted, using pre-intervention and post-intervention tests

    and purposive sampling. Rosenbergs Self-Esteem Scale (RSE), Health Perception Scale (HPS),

    Geriatric Depression Scale Short Form (GDS-SF), and Apparent Emotion Rating Scale (AER) were

    used as study instruments. Each subject was administered pre- and post-experimental tests at a four

    month interval and all subjects underwent weekly individual reminiscence intervention. Forty-eight

    subjects completed the study, with 25 institutionalized elderly people and 23 non-institutionalized

    home-based elderly people. Independent t-tests and paired t-tests were conducted to measure the

    differences in variable means between and within groups. A significant difference was found between

    groups in mood status post-test (t = 5.96, p < .001) and significant differences were noted in self-health

    perception, depressive symptoms, and mood status (t = -2.56, 2.83, -3.02; p = .018, .009, .007) between

    the pre- and post-intervention tests in the institutionalized group. These results suggust that

    reminiscence therapy is especially appropriate for older people who reside in care facilities.

    Implementing strategies that enrich the lives of elderly people residing in long-term cares is crucial,

    and reminiscence offers a method for promoting healthy aging.

    Key Words: reminiscence therapy, self-esteem, self-health perception, depressive symptom, mood status.


    In Taiwan, the elderly population currently constitute

    9.29% of the total population, and is expected to increase to

    20.67% of the population by 2027 (Ministry of Interior,

    2004, August). Elderly adults have been one of the most

    unrecognized and under-served members of the popula-

    tion, especially in terms of care services focused on their

    physical health. Because of the growth of the elderly popu-

    lation, interventions that nurses can perform to improve

    health and the quality of life of the elderly are needed.

    Additionally, elderly adults residing in care facilities are at

    an even greater risk of developingmental problems, such as

    low self-control, depression, and low moods. Cost-

    effective, therapeutic, and non-pharmacological interven-

    tion may therefore be particularly effective for this group.

    Burnside and Schmidt (1994) identified various therapeu-

    tic practices for older people, including reality orientation,

    remotivation therapy, music therapy, dance movement

    therapy, family sculpting, and reminiscence therapy.

    Among these, reminiscence therapy has been considered

    effective in promoting the quality of life and well-being of

    older people in western societies (Chong, 2000). However,

    reminiscence therapy has also been applied in Chinese

    societies such as Hong Kong since the 1980s (Fong, 1993).

    Yet there are very few studies, either in English or Chinese,


    Journal of Nursing Research Vol. 12, No. 3, 2004

    RN, PhD., Associate Professor, Department of Nursing, Fooyin University

    Received:March 25, 2004 Revised: July 16, 2004 Accepted: July 26, 2004

    Address correspondence to: Jing-Jy Wang, No. 151, Chinh-Hsuen Rd., Ta-Liao Rural Township, Kaohsiung County 831, Taiwan, ROC.

    Tel: 886(7)781-1151 ext. 620; Fax: 886(7)783-5112 Email:

  • reporting the effect of reminiscence therapy on older Chi-

    nese people. Research focusing on reminiscence therapy to

    improve the mental health of the elderly has become neces-


    Reminiscence and Self-esteem, Self-Health

    Perception, and Depression

    Low levels of self-esteem; self-health perception, and

    depressive moods often bother Taiwanese elderly people.

    In Taiwan, approximately 33-37% of older adults per-

    ceived their health status as being poor to fair (Wang,

    Snyder, & Kaas, 2001). Menec and Chipperfield (2001)

    studied a group of home-based elderly and discovered that

    low self-rated health predicts poorer functional ability and

    more physician visits and hospitalization. A study con-

    ducted by Bailis, Segall, and Chipperfield (2003) con-

    cluded that peoples perception of health can change in

    response to a variety of events; such as relocating to an

    unfamiliar environment.Wang (2004) conducted a study to

    examine the level of self-esteem among community elderly

    and found that 18.7% of institutionalized elderly and

    19.1% of home-based elderly demonstrated low self-

    esteem. Furthermore, the incidence of geropsychiatric dis-

    orders in elderly residents in long-term care is roughly

    80%, with depression being the most common emotional

    disorder (Jones & Beck-Little, 2002). The prevalence of

    depressive symptoms was found to be 34% to 56% in stud-

    ies conducted in Taiwan (Fuh, Liu, Wang, Liu, & Wang,

    1997; Wang et al., 2001).

    The maintenance of a positive self-image is important

    in helping people to deal with the negative impact of aging

    on their lives. The therapeutic value of reminiscence is

    thought to promote self-esteem and self-worth for people

    in old age (Bulter, 1963). Lappe (1987) used a four-group

    pre- and post intervention test design to examine the effects

    of reminiscence therapy on the self-esteem of the institu-

    tionalized elderly and found significant differences among

    the groups. Research exploring the role of reminiscence

    therapy has indicated that it is a beneficial process associ-

    ated with higher perceptions of personal health and life sat-

    isfaction (Cook, 1991). In addition, failure to integrate

    ones own life experiences is seen as contributing to

    despair and depression (Erickson, Erickson, & Kinvick,

    1986). Studies have examined the benefits of reminiscence

    for the elderly, and concluded that reminiscence generally

    reduces depression and confusion, and increases autonomy

    and life satisfaction (Haight & Hendrix, 1998). Moreover,

    Fry (1983) also conducted structured and unstructured

    reminiscence therapy to treat depression among the elderly

    with positive results, and concluded that reminiscence

    therapy helped the depressed elderly to focus on meaning

    in past life events.

    Unfortunately, very few systematic studies of remi-

    niscence in older Taiwanese people have been published

    except for one study conducted by Hsiao, Yin, Shu, Yeh,

    and Li (2002). Hsiao et al. conducted a reminiscence study

    to examine the effectiveness on depression among the

    elderly. This is the only study examining the effects of rem-

    iniscence on depressed institutionalized elderly, and only

    nine subjects participated in the eight-week study. In addi-

    tion, in HongKong, Fong (1993) conducted a reminiscence

    therapy to alleviate the depression of Chinese older people.

    Both studies found that reminiscence therapy is effective in

    alleviating the depression of older people. No further study,

    however has investigated the effect of reminiscence on

    self-esteem and self-health perception of elderly people

    with the particular purpose of comparing those relocated to

    institutions and those who reside at their own homes. On

    the other hand, Taiwan lacks sufficient psychological care

    to assist elderly individuals to develop to their full potential

    as current health care systems are failing tomeet themental

    health needs of older adults. Nurses need to design thera-

    peutic and innovative interventions. Yet no study has been

    conducted to compare effects of reminiscence on self-esteem,

    self-health perception, depressive symptoms, and mood

    status of elderly people residing in long-term care facilities

    and at home. The purpose of this study thus attempted to

    compare the effectiveness of reminiscence as a therapeutic

    modality for promoting self-esteem, self-health percep-

    tion, and mood status and for lessening depressive symp-

    toms among the elderly who reside in community care

    facilities and at home.

    The theoretical foundation of this study was adapted

    from Ericksons developmental theory and Bulters life

    review process. Erickson (1963) outlined eight stages of

    human development spanning the life cycle from birth to

    death. The final stage is ego integrity vs. despair. The

    elderly must develop ego integrity, a sense of satisfaction

    with life and its meaning and a belief that life is fulfilling

    and successful. According to Bulter (1963), a person who

    achieves ego-integrity in old age will believe that his or her

    life has significance and meaning and is fulfilled. Bulter

    (1963) extended Eriksons theory and believed that ego

    integrity is attained through recalling ones past and an


    J. Nursing Research Vol. 12, No. 3, 2004 Jing-Jy Wang

  • evaluative perspective. This process is called the life

    review, and Bulter (1963) believes it is a universal mental

    process brought about by the realization of approaching

    dissolution and death. According to Atchley (1989),