Psychosocial benefits of solitary reminiscence writing: an exploratory study.

Claims have been made that reminiscence has benefits for older people's psychological well-being, and that writing memories may be a therapeutic process. This paper describes an exploratory study in which five nursing home residents engaged in a process of writing their memories by themselves, in a series of booklets containing memory prompts and photographs, over a period of four weeks. Each completed booklet was typed up by researchers and returned to participants the following week, with a bound copy provided to participants at the end of the study period. Analysis focuses on two sets of data: an in-depth case study of one participant, and a thematic analysis of field notes, researcher reflections, and the written material produced by the other study participants. The case study revealed three main themes: views on the past; sharing the past; and confidence in writing about the past. The field note analysis indicated the presence of four themes: proof and maintenance of skills; psychological or internal processes; social contact; and pleasure in reminiscence. The writing was seen as cathartic and provided a meaningful purpose, an opportunity to exercise writing skills and memory, and a focus for participants to share key stories with others. This exploratory study suggests that there is potential in using solitary writing within a reminiscence framework to improve psychological well-being in older people. However, caution should be exercised when encouraging older people to write their stories. Issues of confidentiality, audience, support, and appropriateness of the activity for the individual need consideration.

Getting the questions right: an example of loss of validity during transfer of a brief screening approach for depression in the elderly.

Screening for depression in the elderly has been advocated to improve detection and management. This article summarises the trend towards briefer screening instruments, and the integration of mental health screening with other assessments. The study aimed to validate a single question depression screen which has previously shown adequate sensitivity and specificity in a new context: a multi-faceted assessment instrument used by nurse practitioners within a community sample of over 75 year olds. The GMS-AGECAT computerised interview assessment was used as a 'gold standard' to determine the accuracy of the depression question in this new setting. Three hundred and twenty-eight patients were screened by their own nurse practitioners, of whom 100 consenting patients underwent a further interview with a research assistant using the GMS-AGECAT. The prevalence of depression was 30%, the sensitivity of the question was 67%, and its specificity 60% (compared with 88% and 71% previously). Responses indicating disability and loneliness were more closely correlated with depression than the depression screen itself. Relevant factors may include: the derivation of the question, the effect of a different sample, altered reliability when used by multiple interviewers, differing patient expectations, and the wording and context of the question within the multi-faceted screening instrument. Depression screening questions need repeated validation when used in different contexts. Patient and staff expectations may influence how screening instruments are used in practice in a way that may also alter reliability. Further studies are needed to establish the causes of loss of validity when screening approaches are used in new settings.