| Objectives:To investigate the reminiscence functions and depression of elderly in community and to find out the factors which influence remininscenc functions of elderly. To explore the effectiveness of the group reminiscence therapy for reducing the depressive symptoms, increasing recovery rate of depression, and improving the self-esteem level, affect balance competence and quality of life of the depressed elderly. Results from this study will provide data for management of the depressed elderly in community by using reminiscence, and to conduct a larger study in the future.Methods:In first part, we applied an epidemiological method combining cross-sectional study in multi-sites to investigate the reminiscence functions and depression of elderly in community of Changsha city and analyze the factors which influence the reminiscence fuctions.Through Jaunary,2008 to May,2008, we applied the stratified cluster randomized sampling method for the screening. At first, we randomly chose eight communities for screening in five districts of Changsha city. According to gender and age stratification, a total of 600 cases of elderly at the age of 60 years or more from communities in Changsha city were investigated. Interview with the smooth and successful record of 455 valid questionnaires, the questionnaire efficiency is 75.83%. Male 197 (43.3%) and 258 women (56.7%),60-95 years of age, the average are is 69.88±7.48. The questionnaires used in this study include self social-demographic information questionnaire, reminiscence function scale and Geriatric Depression Scale (GDS).At the second part of the study, we applied a randomized controlled trial study to explore the effectiveness of group reminiscence therapy for reducing the depressive symptoms, increasing recovery rate of depression, and improving the self-esteem, affect balance competence and quality of late-life of the depressed elderly. This part of the study lasted from June, 2008 to May,2009. Among the eight communities, we applied the simple random sampling method and randomly selected four communities for establishing four intervention groups, and the other four communities for establishing four control groups. Based on the screening results, the eligible depressed elderly who consented to participate were randomly recruited into the study. The sample size was 10-15 subjects in each community. Totally we recruited 129 study subjects (62 in intervention groups and 67 in control groups). Control group received health education, apart from the intervention group received health education, but also accepted group reminiscence therapy, before and after the intervention, we used psychological assessment scales including Geriatric Depression Scale (GDS) Chinese version, Chinese version of Self-Esteem Scale, Affect Balance Scale and SF-36 Chinese version to compare the therapeutic effect.The database was established by Epidata3.0 and statistic analysis were performed using SPSS (version 13.0). Statistical methods included descriptive analysis, Chi-square test, t test, analysis of variance (ANOVA) and regression analysis. Level of significance of this study was set at.05.Results:1. The reminiscence functions of the community elderly and the analysis of the influencing factors(1) The present situation of the reminiscence functions of the community elderly:The study of 455 cases of the reminiscence functions of the community elderly shows that the total score of the reminiscence functions is 144±35.64. Within the 8 domains, the scores from high to low level are:Identity (21.85±6.08), Boredom Reduction (19.20±5.98), Education (17.90±4.98), Conversation (17.81±5.50), Death Preparation (17.38±6.24), Intimacy maintenance (15.38±3.76), Bitterness Revival (14.98±5.62) and Problem Solving (14.52±6.35). Among them the scores of 5 domains including total score of the Reminiscence functions, Identity, Conversation, Intimacy Maintenance and Education all exceed the average value, while 3 domains including Death Preparation, Problem Solving and Bitterness Revival are lower than the average value.(2) The influent factors of the reminiscence functions of the community elderly:Social demography and self-status subjective assessment have a certain influence on the overall reminiscence functions and each domain of the community elderly. The scores of the 3 domains of Identity, Conversation and Bitterness Revival among the females are higher than the males (p<0.05) in the single factor analysis. There are no differences among the overall scores of the reminiscence functions in each age group. The score of Death Preparation shows an ascending trend with the age increase in each domain. The scores of Identity and Bitterness Revival in the divorced and the widowed are both higher than that in the non-divorced (p <0.05). The score differences on the total score of the reminiscence functions and the 7 domains of Boredom reduction, Death preparation, Identity, Problem solving, Conversation, Bitterness Revival and Education due to different education level have statistical significance (p<0.05). In the education level of the elementary school and below, the scores of the elderly on Boredom Reduction, Death Preparation, Conversation and Bitterness Revival are higher than other groups. The influence of vocation on the reminiscence functions mainly shows in the higher scores of Boredom Reduction and Death Preparation in the peasant group as compared to other groups, while the other vocations show higher scores of Bitterness Revival than other groups (p<0.05). The scores of Boredom Reduction and Bitterness Revival in high-income elderly are lower than that in the other groups (p<0.05). Different living styles affect the overall scores of the elderly reminiscence functions and also 5 domains of Boredom Reduction, Death Preparation, Identity, Intimacy Maintenance and Bitterness Revival, and the score differences have statistical significance (p <0.05). Among them, the individuals living alone have higher overall scores of reminiscence functions and 3 domains of Death Preparation, Identity and Bitterness Revival than other living styles. The elderly who have undergone the death of spouses and relatives in the past 1 year have higher scores in the 3 domains of Conversation, Intimacy Maintenance and Bitterness Revival than those who haven't. Among them, the elderly with extreme poor health status and chronic diseases have higher scores on Boredom Reduction, Death Preparation and Bitterness Revival than others (p<0.05). The scores of the elderly with depression screening test positive on 3 domains of Boredom Reduction, Death Preparation and Bitterness Revival are higher than those without, and increase with the aggravation of depression symptoms (p<0.05).The multiple stepwise regression analysis with overall reminiscence functions plus each domains of reminiscence functions as dependent variables and the general information, depression, etc as independent variables shows that:with/ without chronic diseases, self-assessment of health status, depression, living styles, experiencing the death of spouses and relatives in the past 1 year or not, sex, economic status are the factors affecting the overall reminiscence functions; education level, living styles, with/without chronic diseases, self-assessment of health status, depression and economic status are the factors affecting the domain "Boredom reduction"; depression, experiencing the death of spouses and relatives in the past 1 year or not, with/without chronic diseases and self-assessment of health status, age and vocation are the factors affecting the domain "Death preparation"; self-assessment of health status, experiencing the death of spouses and relatives in the past 1 year or not, living styles, and sex are the factors affecting the domain "Identity"; with/without chronic diseases and living styles are the factors affecting the domain "Problem solving"; self-assessment of health status, living styles, economic status and sex have prediction on domain "Conversation"; experiencing the death of spouses and relatives in the past 1 year or not, sex and with/without chronic diseases are the factors affecting the domain "Intimacy maintenance"; Depression, experiencing the death of spouses and relatives in the past 1 year or not, with/without chronic diseases, education level and living styles are the factors affecting the domain "Bitterness revival"; experiencing the death of spouses and relatives in the past 1 year or not, vocation, sex and self-assessment of health status are the factors affecting the domain "Teach".2. Analysis of the effectiveness of group reminiscence therapy for depressive symptoms of elderly(1) The incidence rate of depressive symptoms of elderly was higher in community.455 samples were tested in the sudy. The average score was 8.78±6.44. Among them,165 elderly had different levels of depressive symptoms (GDS≥11), the total rate was 36.26%.138 elderly had mild depression, accounting for 30.33% of total,27 elderly had moderate to severe depression, and accounting for the overall trail was 5.93%.(2) After six week group reminiscence therapy intervention, the GDS score of intervention group declined remarkably compare with the beginning (t=4.61, p=0.00), while the GDS score of control group also change significantly (t=12.75, p=0.00). By covariance analysis, the intervention group and control group GDS scores were significantly different (F=50.81,P=0.00). The recovery rate of intervention group was higher than that of control group (x2= 18.49, p=0.00).(3) After six week intervention, the self-esteem scores of intervention group and control group were no significant increased (p>0.05). By covariance analysis, the difference of self-esteem scores between intervention group and control group also wasn't statistically significant (F= 3.33, p= 0.07). (4) After six-week group reminiscence therapy, the positive affect and affect balance scores of intervention group had increased significantly than that of the beginning(p< 0.01),and the negative affect score had dropped significantly(t=10.74, p=0.00).In control group, after receiving health education, the positive affect and affect balance scores had improved than that of the beginning and the score of negative affect also decreased compared with that before the intervention, but the differences were not statistically significant (p>0.05). By covariance analysis, the intervention group and control group's positive affect, negative affect and affect balance scores were significantly different(F= 49.84, p= 0.00).(5) All subscales of SF-36 were improved to some extent after receiving six week intervention in the intervention group. T test showed that there were significant differences in subscales of bodily pain (BR),general health (GH),vitality (VT),social functioning (SF),role limitation due to emotional problems (RE),mental health (MH),and no significant difference was found in subscales of physical function (PF) and role limitation due to physical problems (RP). In control group, only score of bodily pain (BP) was increased significantly (t=2.69, p=0.01) When compared with the scores of all subscales of SF-36 between the intervention group and control group after six week intervention, the scores of role limitation due to physical problems (RP),bodily pain (BP),general health (GH),vitality (VT),social functioning (SF),role limitation due to emotional problems (RE),mental health (MH) of intervention group were significantly higher than those of control group and the differences are statistically significant, while there was no difference in the scores of BF between the two groups.Conclusion:1. The overall reminiscence functions of elderly in community are optimistic. The major reminiscence functions of the elderly demonstrate as alleviating boredom mood, self-identity, communication, maintaining intimate relationships and education.2. The factors of living styles, self-assessment of health status, with/without chronic diseases, experiencing the death of spouses and relatives in the past 1 year or not, economic status and depression are the related factors that influenced the overall reminiscence functions of the community elderly. The factors of self-assessment of health status and with/without chronic diseases also have great influence on the fuctions of boredom reduction, death preparation, identity, conversation, and bitterness revival. The fuction of death preparation was increasing with age increasing. The fuctions of boredom reduction, death preparation and bitterness revival are influenced by the factor of depression. The factor of experiencing the death of spouses and relatives in the past 1 year or not has the influence on fuctions of intimacy maintenance, bitterness revival and death preparation. Furthermore, the factors of sex, economical status and vacation etc. also have significant influences on different reminiscence functions of elderly.3. The prevalence of depression among the community elderly was high. However, the recognition of the elderly depression is very low.Depression has become main psychological problem of them.4. Since the implementation of group reminiscence therapy in the community can reduce the depressive symptoms, increase recovery rate of depression and improve the quality of life of the community depressed elderly effectively, so it has great significance for improving mental health of elderly and promoting successful aging for them.5. Group reminiscence therapy should be based on the reality of social and cultural background. Implementation of the group therapy process should be followed progressive approach and gradually guide. And also should use a variety of skills (such as caring, listening, positive feedback, accept, and experience sharing, etc.). During the group intervention process, the emotional changes in the elderly should be timely detected and the negative emotions which caused by adverse experiences should be diverted immediately. The rational application of materials for guiding specific memory can also help to achieve the therapeutic effects.6. Group reminiscence therapy is simple, economical and practical, and with the larger socio-economic benefits. So it is feasible and suitable for nursing staffs to carry out in the community.
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