Lifelong Memories That Alleviate Depressive Symptoms of People Living with Early-Stage Dementia: A Mixed-Methods Study

Background: Dementia and depression are the two most common neuropsychiatric disorders in older Americans with 40% experiencing both conditions simultaneously. Yet, interventions addressing both disorders are scarce. Life review is an evidence-based depression intervention. It involves autobiographical storytelling across multiple sessions with a therapist following Erikson’s eight stages of human development. However, cost, stigma, transportation difficulties, and limited therapist availability are common barriers for this population. In response, we developed a life review-based depression intervention, Caregiver-Provided Life Review (C-PLR), for people living with dementia and depression (PwDD) and their family caregivers. We taught life review interview skills to caregivers who then conducted life reviews with their PwDD at home. The purposes of this study were to report PwDD’s most pleasant and challenging life review sessions and how C-PLR can provide substantive activities for dyads to perform together.

Methods: This study reported on the qualitative part of the mixed-methods study. Eligible PwDD were ≥65 years with mild depressive symptoms (≥5 on Geriatric Depression Scale) and early-stage dementia (≥13 on Telephone-Montreal Cognitive Assessment). Caregivers were PwDD’s family members (≥18 years) who cared for PwDD for ≥8 hours/week for ≥1 year. We interviewed caregivers at post-intervention and solicited the most enjoyable and challenging life review sessions for PwDD.

Results: Forty-five caregiver-PwDD dyads completed the study. PwDD were 81 years old (mean), widowed, retired, white, female, and in poor/fair health. Caregivers were 58 years old (mean), married, working, college-educated, white, female, and in good/excellent health. The early childhood session was deemed most enjoyable for both the PwDD and caregivers. PwDD vividly articulated older memories, expressed their enjoyment, and offered more material for discussion. Least enjoyable were the older adulthood sessions with caregivers noticing greater short-term memory loss as the PwDD struggled to converse about more recent life events. Sessions were shorter with fewer memories, and caregivers were challenged by observing more inaccuracies, confusion, and less enthusiasm.

Conclusions: Short-term memory loss among people with dementia is well-documented and consistent with our results. Vivid long-term memories of childhood gradually diminished as each week’s topic moved closer toward the present. This sequential storytelling allows caregivers to closely engage with their PwDD, alerting them to changes in one’s condition that may otherwise go unnoticed. Because a lack of meaningful activities is one of the most common unmet needs in PwDD’s lives, C-PLR may fulfill this need by providing a safe space where PwDD can share personal stories with trusted individuals, conveniently and comfortably from home. This demand for activities presents ever-increasing opportunities for social workers to provide wider varieties of non-pharmacological depression interventions as they, too, experience a demand for their profession. Especially, for PwDD without any living relatives or family nearby, social workers may be the closest trusted individuals with knowledge of the PwDD’s lives. Thus, social workers have a considerable role to play for those PwDD who wish to share their life stories and leave their legacy behind.