The Use of the Life Story Work for older people with and without cognitive impairment The Use of LSB Work for the Cognitively Intact and the Cognitively Impaired Claudia K Y Lai, RN, PhD Associate Professor, School of Nursing The Hong Kong Polytechnic University President, Pi Iota Chapter Honor Society of Nursing Sigma Theta Tau International

The Healing Role of Storytelling (Dean, 1998)  Alcoholics Anonymous  Groups focus on other addictions (food, sex, narcotics, etc.)

Potential Benefits of Sharing a LS (Atkinson, 1998) 1. A clearer perspective on personal experiences and feelings, which brings greater meaning to one’s life. 2. Greater self-knowledge and a stronger self- image and self-esteem. 3. Cherished experiences and insights are shared with others; helps creates community and may show that we have more in common with others than we thought. 4. Joy, satisfaction, and inner peace in sharing one’s story with others.

Cont. Potential Benefits (Atkinson, 1998) 5. Purging, or releasing, certain burdens and validating personal experiences that is central to the recovery process. 6. An inspiration to help others change something in their lives. 7. Others will get to know us and understand us better, in a way that they hadn’t before. 8. By understanding our past and present, we also gain a clearer perspective on our goals for the future.

Uses  Haight ( of life review and LSB work): To promote orderly thinking Decrease depression and burden for people who are stressed Builds self-esteem and independence

Uses of Autobiography (Birren & Birren, 1996)  As a source of psychological and social science research material.  As a source of historical material for family and community.  As a means of promoting personal insight.  As preparation for changes in life.

Using Memory Books in NH Care (Bourgeois et al., 2001)  Results: Revealed improvement on a variety of quantitative conversational measures (e.g., duration of speaking time, frequency of utterances) between treatment and control conditions as a function of memory book use.  The quality of conversations, as measured by the frequency of discourse characteristics (e.g., facilitative behaviors), improved as a function of memory book use for treatment dyads.  Nursing aides’ judgment of residents’ depressive symptoms improved with memory aid use, suggesting changes in resident quality of life as a result of the information that enhanced information sharing and social closeness.

Uses in those afflicted by Alzheimer’s Disease (Cohen, 2002)  Research has found that although biographical videos do not increase the patient’s memory over time, they enhance memories during a given visit and positively alter the experience for the patient and visitor.  Research has shown that viewing the video with the supervision and added interaction of the visitor enhances patient engagement and level of comfort.

Uses in nursing home residents with dementia – a randomized controlled trial Lai, C. K. Y., Chi, I., & Kayser-Jones, J. (2004). A randomized controlled trial of a specific reminiscence approach to promote the well- being of nursing home residents with dementia. International Psychogeriatrics, 16 (1),

Fig 1. Lubinski’s Social breakdown syndrome as applied to communication

Fig 3. Merits of the LSB as an Intervention as suggested by the Literature

Fig 4. Postulations of the Study’s Conceptual Framework

Study Design  A randomized controlled trial - single- blinded, parallel groups (N=101) One intervention group (n=36) One comparison group (n=35) One control [no-intervention] group (n=30)  Outcome measures: SES & WIB  Data collection points: T 0, T 1, & T 2  Interview of staff participated in the study (N=26)

Recruitment and consent Random Assignment Control group Comparison group Intervention group Control group Comparison group Facility data Resident data Demographics SES WIB RAI- ADL MMSE Staff data Resident data Demographics SES WIB RAI-ADL Resident data Demographics SES WIB MDS Same as T0 Same as T1 Process Data to collect Operational Schedule of the Study Preparatory Stage 6 weeks T0T1T2 Time Period Continuous cycle until the sample size requirement is met Staff interview Staff interview MMSE Intervention group

Statistical Analysis  No significant changes were found in the C-MMSE & MDS-ADL when compared the time periods T1 & T0, T2 & T1, and T2 & T0 for each group.  Examined whether the intervention could bring about any significant differences in outcome between the groups over time - no significant differences within subject effects (F=.581, p=.794).  Grouping was examined for any between-subject effects – no significant differences were found for both the SES (F=.049, p=.952) and WIB scores (F=.270, p=.764).

Comparing Outcomes of the Three Groups Using p Values: The ITT Sample Paired Outcomes (Wilcoxon signed rank test) Control Group Comparison Group Intervention Group T 1 -T 0 SES T 2 -T 0 SES *0.032* T 2 -T 1 SES T 1 -T 0 WIB * T 2 -T 0 WIB T 2 -T 1 WIB * p<.05

A Resident ’ s Story

Key Findings from the Study  Enhanced social QOL is possible through the LSB intervention  Appropriate care is possible only through knowing the person  Caring is relating, which occurred at a deeper level through the intervention

Outcomes of Using a Life Story Activity Approach for Community-Dwelling Elderly Claudia K. Y. Lai,1 Mabel M. H. Wong, 2 & Amanda C. Y. Chow 3 1 School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University; President, Pi Iota Chapter, Honor Society of Nursing, Sigma Theta Tau International 2 H.K.S.K.H. Lady MacLehose Centre, Dr Lam Chik Suen District Elderly Community Centre 3 Shatin Integrated Elderly Service, Evangelical Lutheran Church Hong Kong Paper presented at the Annual Congress of Gerontology, Hong Kong, Nov 26, 2005

Objective & Method  Aims at examining whether the production of a life story book (LSB) would lead to a higher level of life satisfaction and an increased sense of self- esteem for older people in the community.  A pre- and post-intervention design comparing outcomes between three different groups  Convenience sampling with participants recruited from 2 NGOs  Recruited participants will be assigned to 3 different groups based on the inclusion and exclusion criteria.  Immediate outcomes (T 1 ) of the intervention will be compared against baseline measurements (T 0 ), and with outcomes three months later (T 2 ).

Inclusion & Exclusion Criteria – General  older adults aged 60 & >;  community dwelling;  able to communicate most of the time (as defined according to the criteria of the Resident Assessment Instrument [RAI] communication scale); and  able to understand and speak Cantonese  any active major psychiatric illnesses, including schizophrenia, bipolar disorders, and depression;  any acute or unstable chronic medical conditions including cardiac or lung diseases;  any active psychosocial crises such as bereavement or relationship problems;  blindness (RAI - vision scale); and  inability to hear even with hearing aids (deafness) (RAI – hearing scale).

Inclusion & Exclusion Criteria – Specific CriteriaGroup 1 By Self Group 2 Volunteer- facilitated (VF1) Group 3 Volunteer- facilitated (VF2) InclusionAble to write up one life story book Unable to write up own life story book because of inadequate literacy level Unable to write up own life story book because of inadequate literacy level; GDS score 5 – ExclusionGeriatric Depression Scale (GDS) scoring 5 or above GDS scoring 5 or above GDS scoring between 0 – 4 and 8 & >

Measures  Outcome Measures  Life Satisfaction Scale  Rosenberg’s Self-Esteem Scale  General Health Questionnaire-30  Control measures  Barthel Index  GDS  Presence of financial strain  Revised Life Events Scale

Discussion  The preliminary results of quantitative data comparing T 0 and T 1 did not support the effectiveness of the intervention in promoting life satisfaction or self-esteem, the research team did observe some qualitative differences in various individuals.  It is possible that the instruments are not sensitive enough to capture changes of a finer magnitude.  It is also possible that the dose of the intervention is not enough.

Conclusion about the effect of LSB work for community dwelling elderly  Findings inconclusive at the moment  Presently still collecting data  Need to compare the outcomes over time (T 0 -T 1, T 1 -T 2, T 0 -T 2 )  Need to examine the qualitative data collected

Use of LSB Work as a Stand Alone Therapy (Rybarczyk & Bellg, 1997)  By themselves, standard reminiscence or life review techniques may serve best as an approach to improving the life satisfaction and adjustment of “worried but well” elderly people.

Benefits to Staff  Staff gained improved knowledge of clients’ identity.  Development of collaborative approach between client, relatives and staff.  Provision of specific information about client care that is important for Staff training Care planning

Uses in Clinical Situations (Bender et al., 1999)  Child care  Moving of a unit

Uses in Counseling and Therapy  Atkinson (1998): when the narrative approach is used by therapists, counselors, or other professional helpers as a guided means for assisting their clients to get to the details of their lives that may prove insightful for understanding long-term patterns, issues, struggles, or dilemmas they are dealing with.

Uses in Research  In education  In gerontology  In studying culture and gender issues

LSB Work for Seniors  What do you think of LSB work?  Is it a worthwhile endeavor to promote the wellbeing of our seniors?  How do you think it should be done?  Is there anything that we can apply?

References  Atkinson, R. (1998). The life story interview. Thousand Oaks, Ca.: Sage.  Bender, M., Bauckham, P., & Norris, A. (1999). The therapeutic purposes of reminiscence. London, UK: Sage.  Birren, J. E., & Birren, B. A. (1996). Autobiography: Exploring the self and encouraging development. In J. E. Birren & G. M. Kenyon (Eds.), Aging and biography: Explorations in adult development (pp ). New York: Springer.  Bourgeois, M. S., Dijkstra, K., Burgio, L., & Allen-Burge, R. (2001). Memory aids as augmentative and alternative communication strategy for nursing home residents with dementia. AAC Augmentative and Alternative Communication, 17,  Cohen, G. D. (2002). Creative interventions for Alzheimer’s disease. Geriatrics, 57 (3), 62,  Haight, B. K. (2001) Life reviews: Helping Alzheimer’s patients reclaim a fading past. Reflections on Nursing Leadership, 27 (1), 20-22,  Lai, C. K. Y. (2003). Improving the Quality of Life for Nursing Home Residents with Dementia: A Life Story Approach. Unpublished doctoral dissertation. The University of Hong Kong: Hong Kong.  Rybarczyk, B., & Bellg, A. (1997). Listening to life stories: A new approach to stress intervention in health care. New York: Springer.