ContentServer (10)
description
Transcript of ContentServer (10)
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. Rosenberg’s 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.
Introduction
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 developing mental 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,
237
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: [email protected]
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-
sary.
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 people’s 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
one’s 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 Hong Kong, 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 to meet the mental
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 Erickson’s developmental theory and Bulter’s 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 Erikson’s theory and believed that ego
integrity is attained through recalling one’s past and an
238
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), as
individuals move from one stage to the next and encounter
changes in their lives, they attempt to order and interpret
changes by recalling their pasts. This provides an impor-
tant sense of continuity and facilitates adaptation. Reminis-
cence can provide a mechanism by which individuals adapt
to changes that occur throughout life. It also entails a pro-
gressive return to an awareness of past experiences, allow-
ing salient life experiences to be reexamined and reinte-
grated. Older people must therefore recall what has hap-
pened before in order to maintain continuity.
Definition of Terms
Reminiscence is defined as recall of past events dur-
ing intervention. Participants are encouraged to talk about
these past events, often assisted by aids, such as photos,
music, objects and videos of the past (Bulter, 1963; Orrell
& Woods, 2001).
Self-esteem is self-acceptance or a basic feeling of
self-worth (Rosenberg, 1965).
Self-health perception is characterized as the evalua-
tion of information that people have about their own health
or personal evaluations of health experiences (Stewart &
Ware, 1988).
Depressive symptoms are characterized as sadness,
low mood, pessimism, self-criticism and self-blame, retar-
dation or agitation, slow thinking, poor concentration, and
appetite and sleep disturbances.
Mood status denotes emotional state, including affec-
tive and psychotic symptoms.
Methods
A quasi-experimental design was conducted utilizing
pre- and post-intervention tests and purposive sampling.
The study instruments were administered via face-to-face
interview and observation.
Sample and Setting
Through purposive sampling, a sample of 58 elders
was recruited from a variety of community care facilities
and home care agencies in southern Taiwan that were free
of similar interventions. The recruitment of subjects for
two groups was terminated when subjects in each group
reached the desired number. Institutionalized elderly are
those elderly people who have relocated to any geriatric
care facility for more than six months and home elderly are
those that reside at their own home. Inclusion criteria
included adults aged 65 years or older, capable of verbal
communication, able to speak either Mandarin or Taiwan-
ese, and demonstrating no obvious cognitive impairments.
Although cut-point score of the Geriatric Depression Scale
(GDS) was not one of the inclusion criteria, participants
showed significant lower post-intervention GDS scores in
both groups compared to their pre-intervention scores.
However, only 52 subjects agreed to participate in this
study and only 48 completed the study, including 25 insti-
tutionalized and 23 home-based elders, death, relocation,
and acute illness, yielding a final completion rate of
82.75%.
Instruments
Four instruments were used for data collection. These
were (1) Rosenberg’s Self-esteem Scale (RSE) (Rosenberg,
1965). The scale consists of 10 items with responses
reported along a four-point scale. Total scores can range
from 10 to 40. The convergent validities on item correlations
were .56 and .83 (Rosenberg, 1965). The scale correlated .59
to .60 with Coopersmith’s Self-esteem Inventory. Reliability
has been shown to be good by Rosenberg (1965) who
reported reproducibility coefficients of .85 to .92. (2) Health
Perception Scale (HPS) by Stewart and Ware (1988). The
HPS is a 5-item subscale from Health Status Questionnaire
(HSQ). Total scores can range from five to 25. The inter-
nal-consistency reliability of the HPS was .87 (Davies &
Ware, 1981). Correlation coefficients with four health
subscales, Physical Functioning, Role Functioning, Social
Functioning, and Mental Health, were .53, .57, .53, and .45,
respectively. (3) Geriatric Depression Scale short form Chi-
nese version (GDS-SF) by Chan (1996). GDS-SF contains
15 items related to psychophysiological indicators of
depression. Respondents answer each of the items with (1)
yes or (2) no in relation to how they have felt over the past
few weeks. Scores can range from 0 to 15 with a cutoff point
of equal to or greater than seven suggesting a large number
of depressive symptoms. The reliability and validity of the
Chinese version used in this study were exceptional. Internal
consistency reliability was .89, test-retest reliability was .85,
criterion-related validity was .95, and concurrent validity
was .96 (Chan, 1996). (4) Apparent Emotion Rating Scale
(AER) by Snyder et al. (1998). AER contains six affective
239
Reminiscence in Mental Health J. Nursing Research Vol. 12, No.3, 2004
states, including pleasure, interest, anger, anxiety, depres-
sion, and tranquility. Total scores can range from 0 to 90.
The scale was administered through direct observation. An
inter-rater reliability of anxiety had the lowest agreement
(82%), while 100% agreement was found for interest.
Cronbach’s alphas of .55 to .58 were found. Furthermore, a
correlation of .30 was found with GDS (Snyder et al., 1998).
Procedure
After institutional and home care agencies’ consent
forms were obtained, the researcher met with individual
subjects, explained the purpose of the study, assured sub-
jects of confidentiality and anonymity, and finally invited
their participation. Written or oral consent was obtained
from each subject before pre-intervention data collection.
Subjects met with the researcher individually and weekly
for 16 weeks, after which a post-intervention measurement
was conducted. To facilitate constancy, both the data col-
lection procedures and the intervention were administered
by the same person. The researchers were licensure and
master’s prepared nurses with a specialty area on geronto-
logical nursing or psychiatric nursing and they had re-
ceived reminiscence training prior to the intervention.
They were alert to any signs of negative emotional reac-
tions of elderly people and to provide rest or terminate the
intervention session.
Intervention
In this study, individual reminiscence served as the
intervention form. Although individual reminiscence ses-
sions are time consuming, one-to-one sessions facilitate a
good relationship between the subject and the researcher.
They also tend to be best for Chinese elderly persons who
are shy in character. In this study, the researcher met with
each subject weekly for-mostly-45 minutes to one hour
over a period of four months. The reasons for this variabil-
ity in the duration of the intervention were the frailty of the
subject and the nature of the reminiscing. The natural ten-
dency to reminisce and recall past events was used during
each reminiscence session except the initial session, which
was for the purpose of establishing a trusting relationship.
Unstructured reminiscing was conducted, during which the
subject was invited to talk about his or her past experiences
or feelings, with no specific topic upon which to reflect
being suggested. However, events such as childhood expe-
riences, marriage, family life, the hardships of war, and
previous jobs were listed as a protocol to serve as hints only
when extended silences occurred. Subjects were free to
repeat any events they wished and the researcher would
focus on listening. There was no difference on the protocol
used between home-based elderly and institutionalized
elderly. Evocative materials, such as old photos, record-
ings of old songs and radio programs, and other relics of the
past were used to evoke memories and stimulate conversa-
tion between researchers and individual subjects.
Results
Demographics
Table 1 lists demographic characteristics for each
group. The subject ages ranged from 65 to 95 years, with
the mean age being 75.69 (SD = 8.11). Male subjects con-
stituted 56.3% of the total while 66.7% of the subjects were
illiterate. The high illiteracy rate is understandable since
the Taiwanese government only began to require six years
of formal education for all children after World War II,
meaning few of the elderly generation received an educa-
tion. Subjects who had lost their spouses, constituted
56.3% of the total and 16.7% had no children. Chi-square
analysis revealed no significant demographic differences
between the institutionalized and non-institutionalized
groups except marital status. A greater proportion of wid-
owed subjects in the institutionalized group seemed unsur-
prising for elderly people who reside in care facilities.
Effectiveness of Reminiscence
Table 2 lists the pre and post-intervention test mean
scores between the institutionalized and non-institutionalized
groups obtained from administering RSE, HPS, GDS-SF,
and AER. Independent t-tests were used to measure the dif-
ferences in variable means between groups. Pre-intervention
analysis revealed no statistically significant difference
between groups in terms of all dependent variables mea-
sured (t = -.31, .46, .71, .60; p = .76, .64, .48, .55 respectively).
However, when the effectiveness of the intervention was
measured by comparing the mean post-intervention scores
of the institutionalized group and non-institutionalized
group, it revealed no significant difference between groups
in terms of self-esteem, self-health perception, and depres-
sive symptoms (t = -.11, 1.70, -1.09; p = .91, .10, .28); how-
ever, a significant difference between groups on mood sta-
tus was found (t = 5.96, p < .001), indicating that the insti-
tutionalized group experienced a significant effect on
mood status after therapy but the non-institutionalized
240
J. Nursing Research Vol. 12, No. 3, 2004 Jing-Jy Wang
group did not. Table 2 also illustrates the effectiveness of
reminiscence therapy within each group, through paired
sample-t analyses. 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 on the institutional-
ized group. However, no significant difference was found
on all dependent variables measured between the pre- and
post-intervention tests on the non-institutionalized group
(p > .05).
241
Reminiscence in Mental Health J. Nursing Research Vol. 12, No.3, 2004
Table 1
Demographic Characteristics of the Study Subjects (N = 48)
Institutionalized (n = 25) Non-institutionalized (n = 23) Total (n = 48)
Variables n % n % n % �2/p
Age .884
65-75 11 44.0 13 56.5 24 50.0
76-85 11 44.0 7 30.4 18 37.5
86 and above 3 12.0 3 13.1 6 12.5
Gender .386
Male 17 68.0 10 43.5 27 56.3
Female 8 32.0 13 56.5 21 43.7
Years of Education .120
Illiterate 19 26.0 13 56.5 32 66.7
1-5 years 6 24.0 3 13.1 9 18.8
6-10 years 0 6 26.1 6 12.5
Over 10 years 0 1 4.3 1 2.1
Marital Status .000***
Married 2 8.0 9 39.1 11 22.9
Widow 18 72.0 9 39.1 27 56.3
Single 4 16.0 2 8.7 6 12.5
Divorced/separated 1 4.0 3 13.1 4 8.3
Income Status .316
Adequate 3 12.0 1 4.3 4 8.3
Fair 14 56.0 10 43.5 24 50.0
Not adequate 8 32.0 12 52.2 20 41.7
Number of Children .092
None 5 2.0 3 13.1 8 16.7
1-3 children 11 44.0 13 56.5 24 50.0
4-6 children 7 28.0 7 30.4 14 29.2
7 and more children 2 8.0 0 2 4.1
*** p < .001.
Table 2.
Pre-Post Tests Between the Institutionalized and the Non-Institutionalized Groups (N = 48)
Institutionalized (n = 25) Non-institutionalized (n = 23)
Pre-test Post-test Pre-test Post-test
Variables M SD M SD p M SD M SD p
Self-h-perception 13.6 5.2 15.9 4.8 .018* 12.9 5.8 13.2 5.8 .826
Self-esteem 24.5 4.6 25.6 3.7 .667 25.0 5.8 25.7 4.4 .401
Depressive sympt. 8.5 4.8 6.3 4.1 .009** 7.6 4.1 7.5 3.7 .901
Mood status 59.4 33.7 76.3 20.7 .007*** 54.8 14.7 51.5 9.9 .233
* p < .05; ** p < .01; *** p < .001.
Discussion
This study was different from previous studies (Cook,
1998; Cook, 1991; Lappe, 1987; Jones & Beck-Little,
2002; Puentes, 2001), in that both institutionalized and
non-institutionalized elderly residents were included and
compared. The results implied that the response of subjects
in the institutionalized group displayed significantly higher
reported mood status compared to the non-institutionalized
group on the post-intervention test measure. This finding is
consistent with other findings supporting the use of remi-
niscence to boost the mood status of institutionalized older
adults (Cull, LaVoie, & Gfeller, 2001; Fry, 1983; Stevens-
Ratchford, 1992). Low mood status resulting from a
depressive institutional environment is predictive and rem-
iniscence therapy may be effective in helping these older
adults to deal with low morale. Additionally, the lack of
communication among residents of long-term care facili-
ties may be detrimental to their mood status and the advan-
tage of one-to-one reminiscence in this study may provide
subjects with an opportunity for self expression.
The results also showed that subjects in the institu-
tionalized group obtained significant benefits from the
intervention and showed significant changes in their self-
health perception, depressive symptoms, and mood status
on the post-intervention test but the non-institutionalized
group only showed a slight improvement in these vari-
ables. According to Bulter, Lewis, and Sunderland (1991),
reminiscence therapy gives relocated older people oppor-
tunities to replace their accomplishments, to resolve re-
placement conflicts, and to find new significance and
meaning in their lives, thereby relieving their depression.
Fry (1983) also confirmed that reminiscence training re-
duces self-reporting of depression by subjects and boosts
feelings of self-confidence and personal adequacy. This
was supported by Berghorn and Schafer’s study (1987),
which concluded that residents whose values adapted to
nursing home life poorly gain more effective outcomes
from reminiscence therapy. Reminiscence may be a thera-
peutic procedure allowing for self-expression and commu-
nication and providing the elderly with a formal outlet for
expressing strong affects, unresolved feelings and fears
which they have tried to repress (Fry, 1983). During ther-
apy, reminiscence therapy also provides a warm, listening
and empathetic environment to help subjects feel free to
engage in overt reminiscence. It thus, boosts their morale
and results in an enhanced mood status.
Although reminiscence therapy has proven to be a
valuable intervention for the home-based elderly (Jones &
Beck-Little, 2002), only slight improvement was found
among the home-based elderly subjects of this study. The
reason may be the high physical functioning of these sub-
jects. Of the home elderly, 78.3% demonstrated a total
independence on ADL (activities of daily living) scores
and only 5.6% had ADL scores below 90. Parker (1995)
postulated that the lower the level of functioning of an indi-
vidual the greater the tendency to reminisce. Thus, elders in
this study who functioned well and adjusted their values so
that they felt relatively similar to the way they felt in their
familiar home environment, were the least likely to be
affected positively by such an intervention.
While the findings of this study are puzzling, they are
consistent with other earlier reports that reminiscing did not
increase self-esteem (Stevens-Ratchford, 1992; Cook,
1991). Several explanations may account for these findings.
While the study extended for 16 weeks, the one hour of rem-
iniscing per week may not have been intensive enough to
change subjects’ self-esteem. Also, the RSE might not have
been sensitive enough for use with this age group since it
was not developed using the elderly population. Finally,
even though there was no statistically significant finding to
support the improvement of subjects’ self-esteem, the group
means indicate that there was a trend in that direction.
This study had some limitations. First, the sample size
for each group was not large enough and was voluneer-
based, thus limiting the generalization of results. Second,
although study sites were restricted to those that were free
of planned intervention, other environmental and personal
variations might still exist among subjects. Additionally,
post-intervention test data were collected only once, imme-
diately following the intervention, so long-term effects
were not recorded.
In sum, the findings imply that participation in remi-
niscence activities is a positive and worthwhile experience
for older institutionalized persons. The findings of this
study can therefore, be applied in long-term care planning.
Long-term caregivers can learn reminiscence therapy in
their daily care of the elderly. However, to ensure reminis-
cence therapy is effective in Chinese societies, nurses also
must consider the specific cultural values and experiences
of older Chinese people. Nurses are needed for evaluating
and designing interventions targeting the mental health
needs of older adults, especially those residing in long-term
care facilities. Consequently, it seems plausible that strate-
242
J. Nursing Research Vol. 12, No. 3, 2004 Jing-Jy Wang
gies for enriching the lives of elderly people residing in
long-term care are crucial, and that reminiscence offers a
method of promoting healthy aging.
Further research should include replication of this
study with a larger sample size, and examine the efficacy of
reminiscence for treating and preventing other mental health
indicators in elderly people suffering from dementia. In
addition, in-depth interviews to explore the common and/or
most effective content and quantity of reminiscence in
stiuations that occur in various life transitions are needed.
Acknowledgment
The author would like to thank the National Science
Council of Taiwan for financially supporting this research
under Contract No. 89-2314-B-242-012 and 90-2314-
B-242-002.
References
Atchley, R. (1989). A continuity theory of normal aging.
Gerontologist, 29(2), 183-190.
Bailis, D. S., Segall, A., & Chipperfield, J. G. (2003). Two
views of self-rated general health status. Social Science
& Medicine, 56, 203-217.
Berghorn, F. J., & Schafer, D. E. (1987). Reminiscence inter-
vention in nursing homes: What and who changes. In-
ternational Journal of Aging and Human Development,
24, 113-127.
Bulter, R. N., Lewis, M. I., & Sunderland, T. (1991). Aging
and mental health: Positive psychosocial and biomedi-
cal approaches (4th ed.). Columbus, OH: Charles E.
Merrill.
Bulter, R. N. (1963). The life review: An interpretation of
reminiscence in the aged. Psychiatry, 26, 65-75.
Burnside, I., & Schmidt, M. G. (1994). Working with older
adults: Group process and technique. London: Jones &
Barlett.
Chan, A. C. (1996). Clinical validation of the geriatric de-
pression scale (GDS): Chinese version. Journal of
Aging and Health, 8(2), 238-253.
Chong, A. (2000). Reminiscence group for Chinese older
people: A cultural consideration. Journal of Gerontolog-
ical Social Work, 34(2), 7-22.
Cook, E. A. (1998). Effects of reminiscence on life satisfac-
tion of elderly female nursing home residents. Health
Care for Women International, 19, 109-118.
Cook, E. A. (1991). The effects of reminiscence on psycho-
logical measures of ego integrity in elderly nursing
home residents. Archives of Psychiatric Nursing, 5(5),
292-298.
Cully, J., LaVoie, D., & Gfeller, J. (2001). Reminiscence,
personality, and psychological functioning in older
adults. The Gerontologist, 41(1), 9-15.
Davies, A. R., & Ware, J. E. (1981). Measuring health per-
ceptions in the health insurance experiment. Santa
Monica, CA: The RAND Corporation.
Erickson, E. H., Erickson, J. M., & Kinvick, H. Q. (1986). Vi-
tal involvement in older age: The experience of old age
in our time. New York: Norton.
Erickson, E. H. (1963). Childhood and society (2nd ed.). New
York: Norton.
Fong, M. K. (1993). Evaluation of the effectiveness of a remi-
niscence group on depressed elderly in alleviating de-
pression. Unpublished bachelor of arts project, City
Polytechnic of Hong Kong.
Fry, P. S. (1983). Structured and unstructured reminiscence
training and depression among the elderly. Clinical Ger-
ontologist, 1(3), 15-37.
Fuh, J., Liu, H., Wang, S., Liu, C., & Wang, P. (1997).
Poststroke depression among the Chinese elderly in a
rural community. Stroke, 28(6), 1126-1129.
Haight, B., & Hendrix, S. (1998). Suicidal intent/life satis-
faction: Comparing the life stories of older women.
Suicide and Life-Threatening Behavior, 28(3), 272-
284.
Hsiao, C., Yin, J. C., Shu, B., Yeh, S., & Li, I. (2002). The ef-
fects of reminiscence therapy on depressed institutional-
ized elderly. Journal of Nursing, 49(4), 43-53.
Jones, E. D., & Beck-Little, R. (2002). The use of reminis-
cence therapy for the treatment of depression in ru-
ral-dwelling older adults. Issues in Mental Health
Nursing, 23, 279-290.
Lappe, J. M. (1987). Reminiscing: The life-review therapy.
Journal of Gerontological Nursing, 13(4), 12-16.
Menec, V. H., & Chipperfield, J. G. (2001). A prospective
analysis of the relation between self-rated health and
health care use among elderly Canadians. Journal on
Aging, 20, 293-306.
Ministry of Interior. (2004, March 30 ). Elderly Affairs. On-
line Ministry of Interior, Executive Yuan, R.O.C. Re-
trieved June 1, 2004, from http://www.vol.moi.gov.tw
Orrell, S. A., & Woods, D. S. (2001). Reminiscence therapy
for dementia. The Cochrance Library, 1, 1-20.
243
Reminiscence in Mental Health J. Nursing Research Vol. 12, No.3, 2004
Parker, R. G. (1995). Reminiscence: A continuity therapy
framework. Gerontologist, 35, 515-525.
Puentes, W. J. (2001). Coping styles, stress levels, and the
occurrence of spontaneous simple reminiscence in older
adult nursing home residents. Issues in Mental Health,
22, 51-61.
Rosenberg, M. (1965). Society and the adolescent self-image.
Princeton: Princeton University Press.
Snyder, M. (2003). Reminiscence. In M. Snyder & R.
Lindquist (Eds.), Complementary/alternative therapies
in nursing (4th ed.). New York: Springer.
Snyder, M., Ryden, M. B., Shaver, P., Wang, J., Savik, K., &
Gross, C. (1998). The apparent emotion rating instru-
ment: Assessing affect in cognitively impaired elders.
Journal of Gerontologist, 18(4), 17-29.
Stevens-Ratchford, R. G. (1992). The effect of life review
reminiscence activities on depression and self-esteem in
older adults. The American Journal of Occupational
Therapy, 47(5), 413-420.
Stewart, A. L., & Ware, J. E. (1988). The MOS short-form
general health survey: Reliability and validity in a pa-
tient population. Medical Care, 26(7), 724-732.
Wang, J. (2004). The effects of reminiscence on self-health
perception and self-esteem of institutionalized elderly in
Taiwan. International Journal of Psychiatric Nursing,
9(3), 1092-1098.
Wang, J., Snyder, M., & Kaas, M. (2001). Stress, loneliness,
and depression in Taiwanese rural commuity-dwelling
elders. International Journal of Nursing Studies, 38,
340-347.
244
J. Nursing Research Vol. 12, No. 3, 2004 Jing-Jy Wang