Measuring engagement among older adults using a multidimensional analysis of communication: Method Design (Preprint)

BACKGROUND Characterising older adult engagement is important to determine the effectiveness of interventions. Engagement is the occupying of oneself in external stimuli and is observable across multiple dimensions of behaviour. Engagement of older adults is commonly investigated on a single behavioural dimension. OBJECTIVE In this article, we present a multidisciplinary approach for measuring and characterising engagement of older adults using techniques appropriate for people with varying degrees of dementia. METHODS Contexts for engagement included a dyadic reminiscence therapy interview and a 12-week technology driven group reminiscence therapy. Participants were older adults (8 female, 1 male, mean age: 79) who attended a day respite facility. Audio-visual recordings of the sessions were processed to analyse facial movement, lexical use, and prosodic patterns of speech. Facial movement was processed using OpenFace to measure the presence and intensity of facial movement. Lexical use was processed using the Linguistic Enquiry and Word Count to measure personal pronoun use, affective word use, and emotional tone of words in speech. Prosodic patterns of speech were processed using custom scripts written in Praat and Python, to measure mean duration of utterances, mean words per utterance, articulation rate and variability of F0. Mixed-effects modelling was used to assess effects of treatment conditions on dependent variable outcomes. RESULTS Results indicate measuring engagement through a multidimensional approach can sensitively capture older adults’ engagement. CONCLUSIONS Application of this method can enhance a researcher’s ability to measure older adult engagement, provide means to compare across interventions and contextual environments, and further develop the science of psychosocial intervention research.

The Effectiveness of Reminiscence Therapy on Alleviating Depressive Symptoms in Older Adults: A Systematic Review

Objective: Depression is one of the most common problems faced by older adults. Reminiscence therapy, defined as using the recall of past events, feelings, and thoughts facilitating pleasure, is one type of psychotherapy that could alleviate depressive feelings among older adults, improve their quality of life, and help them live independently. Reminiscence therapy originated from geriatric psychiatry, and is an effective non-pharmacological intervention that could be structured or unstructured and be conducted individually or in a group. The current systematic review was designed to summarize and review existing evidence on the effect of reminiscence therapy on depression in older adults.Methods: We conducted a systematic review from January 2000 to Mar 2021 using 10 electronic databases in English and Chinese languages, including Medline, Embase, Cinahl, PsychInfo, Cochrane, Web of Science, Google Scholar, Science Direct, CNKI, and WANFANG. We excluded studies that didn't use randomized controlled trials (RCT) from the meta-analysis. The selected studies were scored using the Cochrane Risk of Bias tool. The RevMan 5.0 was used in subgroup analysis depending on how the interventions were classified.Results: We extracted 527 studies based on keyword searches, of which 10 RCTs met inclusion criteria were included in the meta-analysis. The meta-analysis yielded high heterogeneity, and the analyses of significant subgroups showed that reminiscence therapy has a significant effect on relieving depressive symptoms in older adults. Reminiscence therapy benefits older adults with chronic illness and those on antidepressants as well. The effect and cost-effectiveness of group reminiscence therapy were higher than individual reminiscence therapy. And some specific types of group reminiscence therapy have a significant effect on improving depression and secondary outcomes, including life satisfaction. Although the effectiveness of structured and unstructured group reminiscence on depression has no significant differences according to current evidence, the structured therapy is more replicable, generalizable, and user-friendly due to its detailed protocol for new therapists. Furthermore, reminiscence therapy is more effective for older women and older adults with more severe depressive symptoms.Conclusion: Reminiscence therapy significantly increased older adults' remission from depression and quality of life immediately after the intervention. However, the evidence-based protocol and implementation of reminiscence interventions need to be further developed and standardized to facilitate global use. Moreover, it remains unclear on the long-term effect of reminiscence therapy. Based on the limitations of the current study, more rigorous evidence is needed from studies with large sample sizes, RCT design, and longer follow-up periods. Future studies could also explore the effect of different types of reminiscence therapy. Furthermore, qualitative data should be included to better understand older adults' narrative and experiences with reminiscence therapy. Future studies could also investigate the impact of reminiscence therapy on older relatives as a part of outcome measure to explore the efficacious mechanism of reminiscence therapy in alleviating older adults' depressive symptoms.

Intervention Effect of Group Reminiscence Therapy in Combination with Physical Exercise in Improving Spiritual Well-Being of the Elderly

Background: To explore the intervention degree and improvement effect of group reminiscence therapy in combination with physical exercise on spiritual well-being of the elderly after the outbreak of the COVID-19 epidemic. Methodology: In 2020, overall, 130 elderly people were selected from communities in Xiangtan City and Changsha City of Hunan Province, China and randomly divided into two groups, with 65 people in each group. One group was the experimental group that participated in the exercise intervention for 8 weeks as the objects of group reminiscence therapy intervention in combination with physical exercise. The other group was the control group that listened to 4 routine health lectures. Spirituality Index of Well-Being, ULS Loneliness Scale and Brief Resilience Scale were used to evaluate the effect of the intervention. Results: Before the intervention, there was no significant difference between the experimental group and the control group, but after 8 weeks of exercise intervention, the score of loneliness was lower in the experimental group than in the control group (P<0.05), the scores of spiritual well-being and resilience were significantly higher in the experimental group than in the control group (P<0.05); and the differences before and after the intervention were significantly higher in the experimental group than the control group (P<0.05). Conclusion: Group reminiscence therapy in combination with physical exercise could improve spiritual wellbeing and mental health of the elderly.

Interventions for Improving Psychosocial Adjustment in Nursing Home Residents: A Network Meta-Analysis

This study aimed to identify the evidence of interventions for improving psychosocial adjustment in older adults relocating to nursing homes. We followed PRISMA-NMA guidelines to conduct a network meta-analysis. 12 electric databases were used to search for eligible randomized controlled trials (RCTs) and clinical trials (CCTs) from inception to August 27th, 2019. Two reviewers independently conducted article screening, data extraction, and risk of bias appraisal with the Revised Cochrane risk-of-bias tool for RCT and Risk Of Bias for CCT. The network plots were plotted to provide a visual representation of the evidence base. Bayesian fixed-effects pairwise and network meta-analysis were exhibited in the forest plot. A Bayesian network meta-analysis was performed on 30 eligible RCTs with 2119 participants, and 12 eligible CCTs with 491 participants. The quality of the most included studies was rated as moderate in RCTs and low in CCTs. Treatment effects showed that compared to conventional treatment, group reminiscence and group counseling resulted in significant improvements in loneliness (MD: 11, 95%, CI: 2.7–17, SUCRA: 99.5%; MD: 7.7, 95%, CI: 0.53–15, SUCRA: 53.9%, respectively). Similar results were obtained for art therapy (MD: 5.5, 95%CI: 0.8–10, SUCRA: 97.3%) in self-esteem. The model fit was good, and the inconsistency was low. Group reminiscence, group counseling, and art therapy are recommended for reducing loneliness and enhance self-esteem in nursing practice.