There isn’t a single thing we do that isn’t based at least somewhat on memory. Even things that are instinctual, like eating, are tied up with how we remember; we remember what food we like to eat, how to prepare it, where the forks are, how we were taught how to hold a knife, how this tasted on that night when it was warm out and the wind rustled the leaves behind your table.
Put simply, memory is the key to our lives, which is why Alzheimer’s can be so frightening. Who are we if we can’t remember ourselves, or the keys to our lives, or even the basics of functioning? For many people, Alzheimer’s brings up a profound fear of losing oneself.
While that fear is understandable and real, more and more, we’re learning that a person isn’t fully lost when dementia takes hold. There are memories and feelings buried deep in the mind, that can come out in the right circumstances, such as through conversation, music, or scents that trigger deeply-held memories. When encouraged to remember, people often do, even in some late stages of Alzheimer’s.
Deliberate evocation of these memories as part of Alzheimer’s treatment is called “reminiscence therapy”, and it is an increasingly important part of Social Day Programs for San Francisco seniors. It provides a relief for caregivers, a way to get to know someone again, a potential boost for short-term memory, and, most importantly, happiness to a person whose lives have been greatly circumscribed.
Reminiscence therapy, such as the kind practiced at Institute on Aging, can change lives, simply by bringing them back.
Seniors With Cognitive Impairment in San Francisco
California is on the brink of a mental health crisis for older adults. In 2018, the total number of adults over 65 with Alzheimer’s is going to be 650,000. By 2025, a 29% jump will put it at 840,000 people.
This is already taking a toll on our state’s healthcare system. In 2015 (the last year for which we have concrete numbers), there were over 15,000 deaths from Alzheimer’s, a nearly 250% increase since the turn of the century. Additionally, 27,000 people were living in hospice with a primary diagnosis of dementia.
As the population grows and ages, these numbers will only increase, putting a terrible strain not just on the system, but the people working in it. Caregiver burden will increase, with a toll on time and well-being. There is no doubt that caring for someone with Alzheimer’s is a challenge.
That’s why we’re excited about some of the possibilities inherent in reminiscence therapy. They open up avenues not just for a better life, but greater happiness for everyone involved. To understand why, we need to look briefly at how memory works.
Understanding Short-Term and Long-Term Memory
Think about the last time you went shopping or last Thursday’s client meeting. Try to remember driving home from work two weeks ago. Do you remember every aisle you turned down? Do you remember every question that was asked in the meeting? Do you remember how the lights turned at every intersection?
With very few exceptions, the answer is “no”. Our brain can’t remember everything, and so we slowly drop the quotidian and uneventful. Extraordinary events get lodged into our short-term memory and then, through a still-mysterious process, become long-term memories. But much of the meaningless and unremarkable is tossed out (though, granted, our mind sometimes has weird ideas of “meaning”; why do I remember a jingle for a company that closed decades ago?).
Alzheimer’s, in essence, speeds up that process. It erases memories more quickly and more savagely, chainsawing instead of pruning, with no regard for what’s important. Short-term memories never have a chance to take hold.
But that isn’t the case with long-term memories. It turns out that long-term memories, both concrete and abstract, still live somewhere in the brain, waiting to be called to the mind. And that’s where reminiscence therapy comes in. By interacting with the world of memory, true personality comes back. The older adult can become themselves again, can find joy and happiness, and can even have their short-term memory improved.
Reminiscence therapy is nothing less than the art of remembering, which is nothing less than the very act of being human.
The Power of Reminiscence Therapy
In 2005, the National Institute of Health did a study on reminiscence therapy. Here is how they defined it:
Reminiscence Therapy (RT) involves the discussion of past activities, events, and experiences with another person or group of people, usually with the aid of tangible prompts such as photographs, household, and other familiar items from the past, music and archive sound recordings.
They practiced reminiscence therapy on 144 different patients with dementia over four controlled studies with the following outcomes:
The results were statistically significant for cognition (at follow-up), mood (at follow-up) and on a measure of general behavioural function (at the end of the intervention period). The improvement on cognition was evident in comparison with both no treatment and social contact control conditions. Caregiver strain showed a significant decrease for caregivers participating in groups with their relative with dementia.
What does that mean? It means people, including those with dementia, are happy when they can remember things about themselves, especially happy events.
And that’s what reminiscence therapy does. In bringing out a person’s past, it unlocks events long thought buried, by triggering the mysterious tangle of sense memory, mood evocation, and emotion. Think of how you felt on that night at dinner when the wind blew: you can almost smell the jasmine on the summer breeze.
It turns out those memories are there for people even in the late stages of dementia, including Alzheimer’s, although once verbal skills fade it becomes more difficult to unlock. Descriptions of the therapy have been wonderful, with patients bringing back events from decades in the past.
How Does It work?
Let’s assume a person was born in 1940, and so was 24 in 1964. For them, reminiscence therapy might work like this:
- A conversation starts with multi-sensory stimulation (if possible). So we’ll play some Beatles music, the early stuff, when they were on Sullivan and the whole world changed.
- You and/or (hopefully and) a therapist might go through photos from that time period: a wedding, a birthday party, that day at the beach.
- If possible, other senses will be stimulated. If a friend or relative remembers a kind of food your loved one liked or a perfume they wore, maybe try to bring something with that scent.
- Your loved one may participate in activities that involve hands, such as sewing or pottery (if safe). Muscle memory sometimes triggers other memories.
- Then you have a conversation.
It isn’t always effective, of course. The mind is not a puzzle-box to be solved, and probably never will be. But reminiscence therapy often stimulates something. It brings back memories from that time when our long-term memories are best stored, between 10 and 30 (though not limited to that). And a person remembers themselves again.
The impact of this can be magical. There are possible legitimate practical health benefits to it, as there is some evidence that exercising long-term memory can also activate short-term memory. And of course, the simple acts of going out and talking to people, participating in a study, or seeing a regular therapist or therapy group all can help, which is why we emphasize social activities for older adults with dementia and Alzheimer’s.
But what it does most of all is make people happy and bring them together. The patient is happy because (for the most part) they are bringing up happy memories, figurative (or literal) days at the beach, perhaps events they hadn’t thought about for years. Events they didn’t even remember they forgot. Looking back at good times is, simply, good.
There are benefits for you as well. If you are caring for a loved one, you might hear stories you never heard before, or that you hadn’t in years, and you may know your loved one better even as you feared you were losing them. Maybe you’ll remember that this is a person you love, no matter how hard it has been. For professional caregivers, it is a chance to know a person from before they were a client. Overworked caregivers need that to keep them motivated and happy. And a happier client with improved mood makes their difficult and important job somewhat easier.
And really, bringing happiness to caregivers and to clients is a beautiful thing. It is a good unto itself, even without other benefits. It increases the sum total of joy in the world, by turning to that most human thing: memory.
Social Day Program Reminiscence Therapy at IOA
At IOA, we recognize the vital importance of therapy and want to make it easy on clients and caregivers alike. That’s why reminiscence therapy is an integral part of our Social Day Program. In our Social Day Program, your aging loved one will participate in a range of activities designed to support their unique needs. For those struggling with dementia and Alzheimer’s, this includes using innovative services and therapies, like reminiscence therapy, that enhance emotional and cognitive health in a way that is meaningful for each person.
Additionally, we facilitate and arrange in-house or outpatient counseling through our facilities, with trusted, professional psychotherapists. We’ll meet with you and your loved one, ascertain needs and abilities, and connect you with a professional therapist who can integrate reminiscence therapy in their treatment plan. You can come to our place or we’ll go to yours; the level of compassionate, professional care is the same everywhere.
Reminiscence therapy is one of the many services we offer because we don’t feel that San Francisco older adults, or their loved ones taking care of them, should be without help when they are troubled. Mental and neurological health for older adults is a vital issue, and we’re proud to be at the forefront of delivering assistance.
It isn’t easy to watch someone slip away. But there are ways to find them. Connect with us, and let’s start on this journey of reminiscence, together.
At Institute on Aging, our programs and services help older adults, their families, and caregivers explore aging together, through good times and bad, as an adventure and a journey. Contact us today to learn more.