Spiritual reminiscence therapy for older people with loneliness, anxiety and depression living in a

253 Pages·2017·4.13 MB·English

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

Sharifah Munirah Syed Elias
RN BHSc (Nursing) (Hons) MNSc

A thesis submitted for the degree of Doctor of Philosophy at
The University of Queensland in 2017
School of Nursing, Midwifery, and Social Work
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 follow-
up. 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
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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.
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Declaration by author

This thesis is composed of my original work, and contains no material previously published or written
by another person except where due reference has been made in the text. I have clearly stated the
contribution by others to jointly-authored works that I have included in my thesis.

I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance,
survey design, data analysis, significant technical procedures, professional editorial advice, and any
other original research work used or reported in my thesis. The content of my thesis is the result of
work I have carried out since the commencement of my research higher degree candidature and does
not include a substantial part of work that has been submitted to qualify for the award of any other
degree or diploma in any university or other tertiary institution. I have clearly stated which parts of
my thesis, if any, have been submitted to qualify for another award.

I acknowledge that an electronic copy of my thesis must be lodged with the University Library and,
subject to the policy and procedures of The University of Queensland, the thesis be made available
for research and study in accordance with the Copyright Act 1968 unless a period of embargo has
been approved by the Dean of the Graduate School.

I acknowledge that copyright of all material contained in my thesis resides with the copyright
holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright
holder to reproduce material in this thesis.

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Publications during candidature

Peer-reviewed papers

Syed Elias, S.M., Neville, C. & Scott, T. (2015). The Effectiveness of Group Reminiscence Therapy
for Loneliness, Anxiety and Depression in Older Adults in Long Term Care: A systematic
review. Geriatric Nursing, 36 (5), 372-80. doi:10.1016/j.gerinurse.2015.05.004

Conference proceeding

Syed Elias, S.M., Neville, C. & Scott, T. (2015). Reminiscence Therapy for older people suffering
from loneliness, anxiety and depression: A review of the literature: Conference Proceedings
The Fifth Asian Conference on Psychology and The Behavioral Sciences 2015, 26-29. ISSN:
2187-4743. Osaka, Japan: The International Academic Forum

Conference abstracts

Syed Elias, S.M., Neville, C. & Scott, T. (2015). Reminiscence Therapy for older people suffering
from loneliness, anxiety and depression: A review of the literature. Paper presented at The Fifth
Asian Conference on Psychology and The Behavioral Sciences 2015. Osaka, Japan, 26 March
to 29 March.

Syed Elias, S.M., Neville, C. & Scott, T. (2016). The evaluation of a spiritual reminiscence therapy
program for older Malaysian adults with loneliness, anxiety and depression. Paper presented
at the 15th National Conference of Emerging Researchers in Ageing. Canberra, Australia, 31
October to 1 November.

Syed Elias, S.M., Neville, C. & Scott, T. (2016). Spiritual reminiscence therapy – is it effective for
older people? Paper presented at the 49th Australian Association of Gerontology Conference.
Canberra, Australia, 2 November to 4 November.

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Publications included in this thesis

Syed Elias, S.M., Neville, C. & Scott, T. (2015). The Effectiveness of Group Reminiscence Therapy
for Loneliness, Anxiety and Depression in Older Adults in Long-term Care: A systematic
review. Geriatric Nursing, 36 (5), 372-80. doi:10.1016/j.gerinurse.2015.05.004 – incorporated
as Chapter 4.

Contributor Statement of contribution
Author Sharifah Munirah Syed Elias Critically reviewed the paper (80%)
Wrote the paper (70%)
Author Christine Neville Critically reviewed the paper (20%)
Wrote and edited the paper (20%)
Author Theresa Scott Wrote and edited the paper (10%)

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Contributions by others to the thesis

Honorary A/Prof Christine Neville (Principal Advisor), Dr. Theresa Scott (Associate Advisor) and
Dr. Andrea Petriwskyj (Associate Advisor) provided extensive guidance and input into the
development of this thesis and throughout the PhD candidature. All of the supervisors critically
reviewed and provided comprehensive feedback on the content of this thesis multiple times.

Statement of parts of the thesis submitted to qualify for the award of another degree

None
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Acknowledgements

First and foremost, all praises to Allah who has given me the strength to undertake this journey and
successfully reach the end of this PhD journey. May all the knowledge gained from this journey
contribute back to society.

I would like to express my sincere gratitude to my principal advisor, Honorary Associate Professor
Christine Neville for her continuous support of my PhD study, for her patience, motivation and
immense knowledge. I would also like to thank my co-advisor Dr Theresa Scott and Dr Andrea
Petriwskyj for their insightful comments and encouragement and for guiding me in the writing of this
thesis. To all the reviewers throughout my PhD journey (Professor Catherine Haslam, Professor Linda
Teri, Dr Marion Power and Dr John Drayton), thank you for all the constructive feedback and
comments. To Associate Professor Fiona Bogossian who also contributed her knowledge and skills
to my PhD journey, thank you very much.

I would further like to thank my fellow colleagues in the School of Nursing, Midwifery and Social
Work for the stimulating discussions and all the fun I have had throughout this PhD journey. I would
also like to thank all of my friends who supported me in writing, and encouraged me to strive towards
my goal. I would especially like to thank the Malaysian Government and my employer, the
International Islamic University of Malaysia for the SLAI award that has provided financial support
for me and my family. Thank you to the manager of the residential aged care facility, Cheras,
Malaysia (Rumah Seri Kenangan Cheras), Mr. Saiful Bahari and staff, especially Siti Sarah, Yusnita
and others that supported me throughout the data collection process. To the thirty-four residents who
participated in this study, I hope you found participating in my study beneficial.

Last, but not the least, I would like to thank my families in Malaysia for supporting me spiritually in
this journey. A special thanks to my husband, Basri: Thank you for looking after the kids when I was
busy with my thesis and sharing all the sweet and bitter memories of this journey. To my beautiful
and precious children, Rania, Raimi and Raina: Thank you for being such good kids for me, and I
will make sure to compensate all the times that I took from you while doing my PhD.

Thank you for being a part of my PhD journey. Terima Kasih.

“Things ends. But memories last forever.”
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Keywords
aged, anxiety, depression, elder, loneliness, older, reminiscence therapy, residential aged care,
spiritual reminiscence therapy

Australian and New Zealand Standard Research Classifications (ANZSRC)
ANZSRC code: 111001, Aged Care Nursing, 50%
ANZSRC code: 111005, Mental Health, 25%
ANZSRC code: 111718, Residential Client Care, 25%

Fields of Research (FoR) Classification
FoR code: 1110, Nursing 50%
FoR code: 1117, Public Health and Health Services 50%

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This thesis is dedicated to my late older sister, Sharifah Norezah Syed Elias (1980–2002)

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