Evidence-based practice recommendations for working with individuals with dementia: group reminiscence therapy.

In 2001, the Academy of Neurologic Communication Disorders and Sciences (ANCDS), in collaboration with the American Speech-Language Hearing Association (ASHA), its Special Interest Division 2 (SID-2: Neurophysiology and Neurogenic Speech and Language Disorders), and the Veterans Administration (VA) established a committee to write evidence-based practice guidelines for speech-language pathologists (SLPs) serving individuals with Alzheimer dementia. The writing committee developed a technical report with evidence tables, based on a systematic review of the literature related to interventions that SLPs would likely carry out with individuals with Alzheimer disease. In this clinical paper, results of the review related to reminiscence therapy are presented. The six studies reviewed were judged to provide Class II evidence to support the use of group reminiscence therapy to improve the functioning of individuals with Alzheimer dementia. A summary of the evidence supporting group reminiscence therapy is presented, followed by a discussion of practice recommendations and directions for future research.

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The Dementia Practice Guidelines writing committee was charged with the task of developing evidence-based practice guidelines for SLPs serving individuals with dementia. The committee systematically reviewed the literature and classified the evidence according to predetermined criteria. (See Bayles et al. [2005] for a detailed description of the procedures developed by the committee to evaluate the literature.) In this article, one of a series, evidence related to group reminiscence therapy as an intervention for individuals with dementia is reviewed.

Dementia is a syndrome characterized by multiple cognitive deficits, which are sufficient to interfere with daily living and social and occupational functioning (Grabowski & Damasio, 2004). Alzheimer disease (AD), the most common cause of dementia, accounts for approximately 66% of individuals with dementia (Katzman & Bick, 2000). As the risk of AD increases with age, the incidence of dementia will rise dramatically in the coming decades. Indeed, Ripich and Horner (2004) cite the aging of the "baby boomer" generation for creating the fastest growing clinical population served by SLPs.

Whereas many advances in pharmacological management of Alzheimer disease have been made, there still exists a great need for efficacious behavioral management techniques to maintain functioning and quality of life in the growing number of individuals affected by dementing diseases. SLPs, with their expertise in cognition and communication, are increasingly called on to design and implement interventions that either focus directly on the individual with dementia or indirectly through managing aspects of their environment, including interactions with caregivers. Group reminiscence therapy (RT) is an example of a direct therapeutic intervention for individuals with dementia.

WHAT IS REMINISCENCE THERAPY?

Reminiscence is the process of recalling personally experienced episodes from one's past. Based on his theory of "life review," Butler (1963) posited that reminiscing about the past would serve an adaptive function for older adults, whereby they could achieve a sense of psychological well-being and closure in the face of their own mortality. Shortly after Butler's seminal paper, psychotherapists began using reminiscence as a therapeutic approach to improve psychological and social functioning. In studies with cognitively intact older adults, reminiscence therapy has...