Spiritual reminiscence therapy for older people with loneliness, anxiety and depression living in a residential aged care facility, Malaysia: The effectiveness and older people’s experiences

Abstract

Background: Spiritual reminiscence therapy (SRT), a type of spiritual integration in reminiscence therapy (RT), has shown its potential in providing a positive impact for older people living in residential aged care facilities (RACFs). Using a social identity approach, it is expected that SRT can help older people to deal with loneliness, anxiety, and depression by promoting a sense of social connectedness with other people. SRT might be particularly useful for a Malaysian population given the importance of religion and spirituality for Malaysian culture. The practice of SRT is increasing; however, limited studies have investigated the effectiveness of SRT for older people with loneliness, anxiety and depression and these studies have found mixed results. Aim: To determine if a SRT program is effective in reducing loneliness, anxiety and depression for older people living in a residential aged care facility in Malaysia and to investigate its acceptability to this population.Methods: Using the Psychotherapy Adaptation and Modification Framework, the SRT program was modified according to recommendations made by older Malaysian people (N=10) — modifications particularly related to cultural, religious and language differences. The adapted program was piloted with a convenience sample of older Malaysian people (N=10). It was well accepted by the pilot participants, providing a strong basis to conduct a randomised controlled study with older people living in a RACF in Malaysia.A randomised controlled trial design with qualitative components conducted concurrently and sequentially was used. This study was conducted in a RACF in Malaysia, involving permanent residents (N=34) who understood and spoke the Malay language and had been resident for more than four weeks. At recruitment, participants were screened with the Mini-Cog, the Loneliness screening tool, a short form of the Geriatric Anxiety Inventory and the 4-item Geriatric Depression Scale. Participants were randomly allocated to one of two intervention groups or a control group. Participants in the intervention groups received the SRT program in weekly 60–90 minute sessions for six weeks. The control group participated in activities such as painting, drawing and playing games over the same six weeks. Data were collected at pre-test, post-test, and three-month followup. The primary outcome measures were the UCLA Loneliness Scale, the Geriatric Anxiety Scale (GAS) and the Malay version of the 14-item Geriatric Depression Scale (M-GDS-14). The measurement instruments were translated and the translation subsequently verified by translating backwards and forwards between English and Malay. To evaluate the effectiveness of the intervention, the mean scores were compared at baseline, a week after intervention and at three-month follow-up.To investigate participants’ experiences of the program and its acceptability with this population, observations were recorded during the six weeks of intervention sessions. Seven participants in the intervention groups also participated in a focus group discussion (FGD) after completion of the intervention to share their experiences of the SRT program.Results: Of 180 residents, 34 participated, with 18 participants in the intervention groups and 16 in the control group. Participants in both groups were in the young old age group (Intervention: M = 67, SD = 4.67 and Control: M = 69, SD = 6.60). Chronic medical illness burden was low (M = 2.12, SD = 2.10). The dropout rate was 8.8%. The main effect between groups was not significant, suggesting no difference between the intervention groups and the control group for the UCLA Loneliness Scale, GAS and M-GDS-14 scale. Within-group analysis revealed that both the intervention groups and the control group showed a significant mean difference for the UCLA Loneliness Scale and the M-GDS-14 scale. Post hoc comparisons showed that UCLA Loneliness Scale mean scores for the intervention groups in the pre-test were significantly improved from the scores at three-month follow-up. UCLA Loneliness Scale mean scores for the control group showed a significant improvement from pre-test to post-test, but not between post-test and three-month follow-up. M-GDS-14 mean scores for both groups were significantly improved from pre-test to three-month follow-up. Analysis of focus group and observational data relating to participants’ experiences and acceptability of the SRT program revealed four themes: enthusiastic participation and enjoyment of the program, connection-making across boundaries between participants, use of the sessions as space for expressing and reflecting, and successful use of triggers.Conclusion: Although the findings showed no significant between-groups differences, there were significant within-groups differences for loneliness and depression. This finding suggests SRT is a worthwhile program and a future development of SRT among older people living in RACFs is supported. The significant within-group results for the control group on measures of loneliness and depression suggest the value of group based interventions in RACFs. While the findings did not confirm the effectiveness of SRT as a whole, they suggested that SRT was not only an acceptable and enjoyable experience for the participants, but developed a shared identity and connectedness across perceived differences, as social identity theory predicts.