Reynolds GET-IT Program

SAGE Program Session 1

Life Reminiscence as a Clinical Tool

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Adapted By: Maureen Dever-Bumba, DrPH (c); USC Sarah Schumacher, DO; USC

Original By: Kay F. McFarland, M.D.; USC Donna R. Rhoades, Ph.D.; USC Ellen Roberts, MPH, Ph.D.; USC

Edited By: Maureen Dever-Bumba, DrPH (c); USC Nancy A. Richeson, M.D.; USC Sarah Schumacher, DO; USC Joshua T. Thornhill IV, M.D.; USC Jennifer Heffernan, M.D.; UNTHSC

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program Life Reminiscence

CM-IV SAGE Program LIFE REMINISCENCE AS A CLINICAL TOOL

Goal: You will understand the benefits of life reminiscence and patient-centered interviewing when assessing psychosocial issues, spiritual beliefs, and health perceptions in older adults

Session Competencies:

Attitudes The student will be able to: 1. Appreciate when and why life reminiscing may be of value to healthcare professionals and older adults

Knowledge The student will be able to: 1. Discuss the role of communication skills in patient-provider satisfaction 2. Describe the psychosocial and developmental stages that are associated with older adults 3. Discuss the role of life reminiscence in treatment of depression in older adults

Behaviors and Skills The student will be able to: 1. Take, read and interpret a blood pressure and pulse 2. Communicate effectively using active and reflective listening 3. Utilize patient-centered interviewing to conduct a brief clinical life reminiscence.

Equipment/Material to Take to the Interview

1. White coat and nametag 2. Blood Pressure Cuff, Stethoscope 3. Senior Mentor/Client Signature/Blood Pressure Card (SAGE card) 4. Senior Mentor/Client Life Reminiscence Discussion guide 5. Instructions 6. MOW parking placard

Instructions to Students:

Summary and Background: Sometimes we remember because our memories have been triggered involuntarily by a favorite song or tune and sometimes we remember on purpose. Reminiscing gives us a pleasure and a sense of relatedness and connection with what has gone before. Reminiscence allows us to relive events from our past. It is a process which focuses on the personal way we experience and remember events, rather than on chronological or historical Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Life Reminiscence accuracy. When we reminisce we don’t simply recall random events in a cold factual way. With reminiscing we are able to relive the experiences that are personal to us in a way that is vivid and engaging.

Reminiscing encourages older people to become actively involved in reliving and sharing their past with others. Although reminiscence involves recalling past events it encourages the elderly to communicate and interact with a listener in the present. Involving an older person in reminiscing has many benefits for that person.

Some of these benefits are:  Increase the ability to communicate and practice self-expression.  Increase social interaction through the sharing of experiences.  Increase feelings of belonging and togetherness.  Emphasize the individual identity and unique experiences of each person.  Allow the older people to take on a teaching role through the sharing of their experiences.  Help people to come to terms with growing older.  Encourage creativity.  Increase self-worth and provide a sense of achievement.  Reduce apathy and confusion, especially in confused or disorientated people.  Alleviate depression.

Life Reminiscence is different than a related tool, life review. Life review focuses on broad themes like family history, accomplishments, and turning points. This requires that people have the ability to review their life, to select the most important events, to summarize them and find a meaning in them. For some people this may be too complicated. In the life reminiscence, explicit and narrowly focused themes are selected and more structure is given during the interaction.

Steps for Module:

Step One: Read the article below along with the Senior Mentor/Client Life Reminiscence Discussion Guide at the end of this Session:

o Morgan, A. (2003) Psychodynamic Psychotherapy with Older Adults. Psychiatric Services . Vol. 54 No. 12

Step Two: Visit your senior mentor/client. Introduce yourself as a healthcare professional student from UNT Health Science Center in Fort Worth. Thank your senior mentor/client for participating in your education. Inform them that you are not their physician/healthcare professional and you cannot give any medical advice. Ask if your senior mentor/client has any questions before you get started.

Begin the session by taking your mentor’s blood pressure. Don’t forget to record it on the blood pressure card and your senior mentor’s/client’s blood pressure log. Have your senior mentor/client sign and date your card.

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Life Reminiscence

Step Three: Choose 2-4 possible themes or areas that you think you will concentrate on during this interview. Possible themes and approaches are listed later in the instructions. Think about how these themes may relate to developmental stages, tasks, or difficulties in later life. Involve the mentor in the final choice for starting point.

Step Four: Conduct a brief (1/2 -1 hour) life reminiscence with your mentor/client using a patient-centered interviewing approach (active listening).

Step Five: After the interview, reflect back on the experience. Address the following student questions below.

Assignment Due Date: 72 hours after senior client visit. This assignment is to be submitted electronically to Blackboard.

The following are to be posted on blackboard for your faculty mentor to review:

POST UNDER “ASSIGNMENT” TAB

1. The date and time you visited your senior mentor/client

2. Client’s blood pressure and pulse

3. Summarize the story that your mentor/client told.

4. What were the main issues or topics that surfaced during the interview? How do they relate to the developmental stages, tasks, or difficulties in this mentor’s/client’s later life?

5. What problems or difficulties did you encounter in conducting the interview with your senior mentor/client? How did you handle them?

6. What were your mentor’s/client’s reactions to the interview?

7. What insights were derived from the life interview by your mentor/client?

8. What did you do best when listening to the mentor/client? How could you improve your listening and/or integrative skills?

9. How might this exercise be helpful to you as a healthcare professional?

10. What other comments would you like to make about this session with your mentor/client?

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Life Reminiscence

REMEMBER TO HAVE YOUR SENIOR MENTOR/CLIENT SIGN YOUR SAGE CARD FOR THIS VISIT

Senior Mentor/Client Life Reminiscence Discussion Guide

1. Ask evocative questions rather than those requiring only a yes or no answer.

Encouragers:  Tell me more.  Where did that lead?  How did that affect or influence you?  What meaning does that have for you?

2. There will be some topics that will not work. Some sensitive issue cannot be approached even when trust is developed. You may be the wrong age or sex. That is okay, just expect it. 3. Take a low key approach. This helps ease both you and the mentor/client into the interview role. 4. Show interest through body language but don’t crowd. Interject remarks, take part in the conversation but don’t take over. Learn to be a good listener. 5. Know what questions you want to ask, but don’t be afraid to let your informant go off on a tangent. Getting back on track:  “Before you told me about this or that we were talking about so and so.  Can you tell me how so and so was affected when?

6. If you need to write down questions, put them on note cards (one or two to each card). 7. Use props whenever necessary. 8. Be sensitive to the needs of the mentor, they may tire easily especially with emotional topics

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Life Reminiscence

Brief Life Overview Approach

. What is your first memory of life (or one of your significant first memories) . Tell me about your family history (genealogy): who were your grandparents, where did the come from, what did they do for living, what kind of people they were? If you knew them personally, what kind of relationships did you have with them? Are there any powerful memories you have of them? How are you similar/ different with your grandchildren? . Same for parents (and siblings) . Tell me about the values you absorbed in your family of origin. How did you learn them? What values you decided to transfer to your own family? How did you teach them? . Significant life events: Talk about living in your parent's home, meeting your partner (if both partners present each one can tell his version), moving away from home the first time, first job, first child, exciting moments in raising the kids, first great loss, retirement…. . Can you talk about your philosophy of life- What are the values that are most important to you? What kept you going and hoping during difficult times? . What is your personal legacy to the significant people in your life? What way do you want them to follow in the future?

Potential Themes for Discussion

I was born My mother Family life My father Sundays My brothers and sisters Toys and treats Other relatives Christmas day First memories Favorite food My childhood home Heroes Favorite rooms, things Radio, music In the backyard Turning 21 Our neighbors Cars Our childhood games The great depression Childhood pets During the war Our town Child, other commitments Childhood disasters Love, marriage Childhood illness Work Childhood fears Special friends Childhood songs, street games Hurdles, heartbreaks Regrets

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Potential Starter Questions for Discussion

Avoid using yes/no questions, but rather re-structure it as open-ended

Great questions for anyone

 What was the happiest moment of your life? The saddest?  Who was the most important person in your life? Can you tell me about him or her?  Who has been the biggest influence on your life? What lessons did they teach you?  Who has been the kindest to you in your life?  What are the most important lessons you’ve learned in life?  What is your earliest memory?  Are there any words of wisdom you’d like to pass along to me?  What are you proudest of in your life?  When in life have you felt most alone?  How has your life been different than what you’d imagined?  How would you like to be remembered?  Do you have any regrets?  What does your future hold?  Is there anything that you’ve never told me but want to tell me now?  Is there something about me that you’ve always wanted to know but have never asked?

Friends

 What is your first memory of your best friend?  Was there a time when you didn’t like this friend?  What makes/made you such good friends?  Describe this friend to me? How would you describe yourself at that meeting?

Grandparents

 Where did you grow up?  What was your childhood like?  Who were your favorite relatives?  Do you remember any of the stories they used to tell you?  How did you and grandma/grandpa meet?  What was my mom/dad like growing up?  Do you remember any songs that you used to sing to her/him? Can you sing them now?  Was she/he well-behaved?  What is the worst thing she/he ever did?  What were your parents like?

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program Life Reminiscence

 What were your grandparents like?  How would you like to be remembered?

Raising children

 When did you first find out that you’d be a parent? How did you feel?  Can you describe the moment when you saw your child for the first time?  How has being a parent changed you?  What are your dreams for your children?  Do you remember when your last child left home for good?  Do you have any favorite stories about your kids?

Parents

 Do remember what was going through your head when you first saw your children?  How did you choose the name(s)?  What were they like as a baby? As a young child?  Do you remember any of the songs you used to sing? Can you sing them now?  What were the siblings like? What were the hardest moments you had when your children were growing up?  If you could do everything again, would you raise them differently?  What advice would you give me about raising my own kids?  What are your dreams for children, grandchildren, great grandchildren?

Growing up

 When and where were you born?  Where did you grow up?  What was it like?  Who were you parents?  What were your parents like?  How was your relationship with your parents?  Did you get into trouble? What was the worst thing you did?  Do you have any siblings? What were they like growing up?  What did you look like?  How would you describe yourself as a child? Were you happy?  What is your best memory of childhood? Worst?  Did you have a nickname? How’d you get it?  Who were your best friends? What were they like?  How would you describe a perfect day when you were young?  What did you think your life would be like when you were older?  Do you have any favorite stories from your childhood?

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Life Reminiscence

School

 Did you enjoy school?  What kind of student were you?  What would you do for fun?  How would your classmates remember you?  Are you still friends with anyone from that time in your life?  What are your best memories of grade school/high school/ college/ graduate school? Worst memories?  Was there a teacher or teachers who had a particularly strong influence of your life? Tell me about them.  Do you have any favorite stories from school?

Love and relationships

 Do you have a love of your life?  When did you first fall in love?  Can you tell me about your first kiss?  What was your first serious relationship?  Do you believe in love at first sight?  Do you ever think about previous lovers?  What lessons have you learned from your relationships?

Marriage

 How did you meet your husband/wife?  How did you know he/she was "the one"?  How did you propose?  What were the best times? The most difficult times?  Did you ever think of getting divorced?  Did you ever get divorced? Can you tell me about it?  What advice do you have for young couples?  Do you have any favorite stories from your marriage or about your husband/wife?

Working

 What do you do for a living? Tell me about how you got into your line of work.  Did you like your job?  What did you think you were going to be when you grew up?  What did you want to be when you grew up?  What lessons has your work life taught you?  If you could do any job now, what would you do? Why?  When did you retire? How did you feel about it then? And now?  Do you have any favorite stories from your work life? Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program

Life Reminiscence

Religion (explore this area with caution)

 Can you tell me about your religious beliefs/spiritual beliefs? What is your religion?  Have you experienced any miracles?  What was the most profound spiritual moment of your life?  Do you believe in God?  Do you believe in the after-life? What do you think it will be like?  When you meet God, what do you want to say to Him?

Serious Illness (explore this area with caution)

 Can you tell me about your illness?  Do you think about dying? Are you scared?  How do you imagine your death?  Do you believe in an after-life?  Do you regret anything?  Do you look at your life differently now than before you were diagnosed?  Do you have any last wishes?  If you were to give advice to me or my children, or even children to come in our family, what would it be?  What have you learned from life? The most important things?  Has this illness changed you? What have you learned?  How do you want to be remembered?

Family heritage

 What is your ethnic background?  Where is your mom’s family from? Where is your dad’s family from?  Have you ever been there? What was that experience like?  What traditions have been passed down in your family?  Who were your favorite relatives?  Do you remember any of the stories they used to tell you?  What are the classic family stories? Jokes? Songs?

War

 Were you in the military?  Did you go to war? What was it like?  How did war change you?  During your service, can you recall times when you were afraid?  What are your strongest memories from your time in the military?  What lessons did you learn from this time in your life?  What was it like for your family while you were away?

Adapted from the University of South Carolina Senior Mentor Program 11/11 Reynolds GET-IT Program