Reminiscing benefits elderly patients’ health
Reminiscing benefits elderly patients’ health
Researchers say social contacts improve outcomes
In dealing with home care patients, attending to their immediate and long-term medical concerns, it can be easy to forget they have lives and histories apart from their ill health. Because of their homebound status, patients’ interactions with nurses, aides, and other home health workers may constitute their only significant social contact with the outside world.
Two Minnesota researchers argue that by encouraging elderly patients to reminisce about their families, careers, and other personal experiences, caregivers such as family and home health staff can help improve the quality of their lives — or even prolong them.
"The research that we did showed that when people are engaged with others in meaningful ways, there is an increase in trust and a greater sense of well-being," says Howard Thorsheim, PhD, LP, a professor of psychology at St. Olaf College in Northfield, MN.
Thorsheim and his colleague, Bruce Roberts, PhD, also a professor of psychology at St. Olaf, analyzed responses from nearly 2,200 people to questions regarding social support with family and friends. They found that these interactions, as well as opportunities to receive esteem from others and talk about their interests, began declining as early as age 20 and dropped precipitously after retirement.
Citing a Harvard study suggesting that social and productive activities are as effective as fitness activities in lowering the risk of death, Thorsheim and Roberts have gone further, linking meaningful reminiscing to lowered blood pressure and heart rates in participants.
The two have written a book, I Remember When: Activity Ideas to Help People Reminisce, outlining their findings and suggesting programs for caregivers to help patients reminisce.
Thorsheim and Roberts say home health care workers can help improve patients’ outlook, and even their health, by drawing them into conversations that get their minds off their medical problems.
"One of the things it seems to do for people is to give them a different identity, if only for the moment, in the way they think about who they are," Roberts says. "It would be easy for people to think of themselves as a person with a bad gall bladder or a broken arm or whatever it is. When you ask them to tell a story about something that’s meaningful, that broadens their sense of who they are at the moment."
He and Thorsheim describe the physical transformation they’ve seen in elderly patients as they reminisce: smiling and "brightening up."
"All of these things are sort of powerful for a person as far as effecting a sense of well-being and a sense of who they are," Roberts says.
Trust, active listening are key
Thorsheim and Roberts identify key skills in helping people reminisce:
- Helping people talk. Encourage them to talk about things that are meaningful to them. The simplest tactic, and the one most easily used in the home, is pointing to an object and asking the patient, "What’s the story behind that?"
Thorsheim says choosing an item that’s on display and clearly valued, such as a photograph or knickknack, is likely to elicit a response. "So when given permission or encouragement by a rather open question, it gives [the patients] an invitation to tell something they like to talk about," he says.
Roberts offers an example provided by a home health aide they interviewed. The aide described dealing with an uncommunicative client and having little success, until the day she commented on a photograph of a dog she noticed. "She asked, Is that your dog?’ and the person lit right up," he says. "She said Oh, yes,’ and told her the name of the dog. The aide said, Tell me more about it,’ and the client went on and on about the dog."
When it looked as though the patient had little more to say, the aide said she had a dog, too, and they began comparing their pets. "From that point on, those two had a really strong interest in dogs in common, and it was always something they could talk about," Roberts says. "They both enjoyed the conversation immensely."
- Listening actively. Thorsheim and Roberts also refer to this as "respectful listening" — maintaining eye contact with the speaker, asking open-ended questions ("Can you tell me more about that?"), paraphrasing the speaker’s words, and reflecting on the emotions the speaker demonstrates in telling the story.
Thorsheim and Roberts say it’s important to give speakers the opportunity to tell the story the way they want to, without interruption. But they say helping people reminisce doesn’t always have to take a lot of time. A student once told them about a doctor she admired, who, in the course of a two-minute check on hospital rounds, could draw patients into talking about their former careers or other personal information, simply by a well-placed question or two. "It doesn’t require that you have an hour and a half in order to get to know the person, but it’s something that can be done in the course of other activities," Roberts says.
- Helping people gain trust. There are limits to what people will tell you without trusting you to respect the information, keep it confidential, if necessary, and not stray into areas they don’t want to talk about. Establishing that trust is important in the early stages of a relationship. Thorsheim says that’s why it’s best to begin with something on display, because a person would be more likely to display an item they’re willing to talk about with strangers.
"You’re clearly not asking someone to tell you all of their personal secrets and life history," he explains. "It’s very focused. There’s kind of a covenant between the asker and the storyteller that [the item] is what they’re talking about."
- Overcoming obstacles. For many elderly people, physical or mental infirmity, such as hearing loss or a failing memory, can make it difficult to reminisce. To better enable the speaker to hear questions and responses, Thorsheim and Roberts suggest choosing the setting carefully. A setting such as a kitchen, with shiny surfaces on floors and counters, allows sounds to bounce around and causes audio clutter that makes it difficult for people to hear a conversation. Outside noises such as traffic, children, or machinery can drown out what’s being said as well.
Roberts suggests talking in the living room, where drapes, carpet, and upholstered furniture soften noise. When he visits his mother-in-law, he makes a point of drawing a stool up close to her, not just to facilitate hearing, but to demonstrate that what she’s saying to him is important.
To cope with mental lapses, the key is to ask open-ended questions rather than specific ones that can frustrate the speaker. "If someone asks, What’s the name of the person in this picture?’ I might have trouble with that kind of question," Thorsheim says. "But if someone says to me, Tell me about this picture,’ I can say it was snowing that day. A closed question can put a person on the spot."
He notes that research has shown storytelling to be one of the easiest ways for people to retain complex information longer.
Learning through experience
Each year, Thorsheim and Roberts conduct an exercise with their students aimed at showing the value of reminiscing. They hold a "bring-a-thing" get-together, where students bring in objects, then are paired off to discuss them with someone else. The activity helps people focus on active listening skills and gives them the experience of being heard. "People will find that it’s a meaningful experience to be listened to, to talk to another person about this object that is meaningful to them," Thorsheim says.
He and Roberts suggest holding an informal "bring-a-thing" inservice to help staff understand the value of encouraging patients to reminisce. A positive side effect of such an exercise is that the staff may discover a newfound appreciation for each other’s experiences, a valuable component to enhancing teamwork among home health care workers.
"To tell stories about ourselves helps in building a sense of community," Thorsheim says. "We’re encouraging people to do that, as well as helping people listen to each other."
• For more on I Remember When: Activity Ideas to Help People Reminisce, contact Elder Books, P.O. Box 490, Forest Knolls, CA 94933. Telephone: (800) 909-2673. Web site: www.elderbooks.com.
• Howard Thorsheim, Professor, Department of Psychology, 1520 St. Olaf St., St. Olaf College, Northfield, MN 55057. Telephone: (507) 646-3144. Fax: (507) 646-3774. E-mail: [email protected].
• Bruce Roberts, Professor, Department of Psychology, 1520 St. Olaf St., St. Olaf College, Northfield, MN 55057. Telephone: (507) 646-3147. Fax: (507) 646-3774. E-mail: [email protected].
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