Received: 10 February 2017
Accepted: 18 September 2017
DOI: 10.1002/gps.4822
RESEARCH ARTICLE
Evaluation of MESSAGE communication strategy combined
with group reminiscence therapy on elders with mild cognitive
impairment in long‐term care facilities
| Peng‐cheng Liu1
Huan‐huan Zhang1,2
Mei‐ling Zhang1 | Jiao Sun1
1
School of Nursing, Jilin University, PR China
2
The Second Affiliated Hospital Zhejiang
University School of Medicine, PR China
Correspondence
Jiao Sun, School of Nursing, Jilin University, PR
China, No. 965 Xinjiang Street, Chaoyang
District, Jilin, PR China.
Email: sunjiao@jlu.edu.cn
Objective:
|
Jie Ying1
|
Ying Shi1
|
Shou‐qi Wang1
|
This study aims to evaluate combined effects of MESSAGE communication strategy
and group reminiscence therapy (GRT) on elders with mild cognitive impairment (MCI) in long‐term
care facilities in Changchun, China.
Methods:
This study is a nonrandomized controlled trial. Subjects included 60 elders with MCI.
Participants were divided into intervention (MESSAGE communication strategy combined with
GRT) and control groups (without any intervention). Primary outcomes comprised cognitive function
and quality of life of elderly people, as measured by the Beijing version of the Montreal Cognitive
Funding information
Jilin University, Grant/Award Number:
2016224
Assessment and the Chinese (mainland) version of Short‐Form 36 Health Survey assessment.
Results:
We observed significant changes in cognitive function with mean difference of 1.962
after 12 weeks (P = .000; 95% confidence interval [CI] = 1.341, 2.582), delayed memory dimension of 1.115 (P = .003; 95% CI = 0.417, 1.813). The intervention group exhibited the following
improvements: general health of 14.731 (P = .000; 95% CI = 8.511, 20.951), mental health of
21.038 (P = .000; 95% CI = 17.301, 24.776), role‐emotional of 26.925 (P = .003; 95% CI = 10.317,
45.533), and vitality of 14.231 (P = .000; 95% CI = 10.084, 18.377).
Conclusions:
Using a sample of Chinese elderly people with MCI and residing in long‐term
care facilities, we concluded that application of MESSAGE communication strategy combined
with GRT resulted in improved cognitive function and quality of life.
KEY W ORDS
elders, group reminiscence therapy, long‐term care facilities, MESSAGE communication strategy,
mild cognitive impairment
1
|
I N T RO D U CT I O N
illness that progresses through a period when symptoms are initially
mild and interventions possibly work more effectively. Among Chinese
Dementia comprises progressive neurodegenerative disorders that
elderly people (age ≥ 60 y), incidence rate of MCI totals 12.7%,4 and
affected 46.8 million people worldwide in 2015, with 9.5 million
10% to 15% of people with MCI exhibit Alzheimer's disease progres-
(20.3%) identified in China; in people aged 60 years, prevalence of
sion each year5,6; therefore, early intervention must be highly consid-
dementia reaches 4.3%.1 In several regions in China, prevalence of
ered for people such condition. In recent years, increasing attention
Alzheimer's disease accounts for
focused on nonpharmacotherapy practices, such as cognitive therapy,7
majority of dementia cases among elderly people. Dementia not only
music therapy,8 and reminiscence therapy.9 Basing on improved
affects cognitive function, mood, and daily activities of individuals
preservation of long‐term memories than recent episodic memories
but also quality of life of their families combined with staggering
in both older and dementia patients,10 researchers discovered that
economic burden on relatives and nations.
reminiscence therapy can be significantly used to stimulate long‐term
2
dementia totals 0.8% to 7.5%.
Corbyn3 showed that early diagnosis of mild cognitive impairment
(MCI) stems from the assumption that people with dementia feature an
Int J Geriatr Psychiatry. 2018;33:613–622.
memories of patients with dementia with aid of guide materials, such
as old photos, life story books, recordings, and old songs.
wileyonlinelibrary.com/journal/gps
Copyright © 2017 John Wiley & Sons, Ltd.
613
614
ZHANG
ET AL.
Group reminiscence therapy (GRT) can encourage participants to
interact and share their own life experiences. Current research focuses
Key points
on improving cognitive functions, quality of life, and decreasing depres-
• This work is the first study to apply communication
sion of patients with dementia and elderly people with MCI using
strategy combined with group reminiscence therapy
GRT.11 Reminiscence therapy combined with other cognitive enhance-
(GRT) among elders with mild cognitive impairment
ment (process‐based cognitive training) can also improve cognition and
(MCI) in long‐term care facilities in China.
quality of life in elderly people with MCI.12,13 However, the study of
Barban et al10 failed to confirm efficacy of this method in patients with
• In redesigning theme content, application of low‐level
MCI. Thus, we suggest conducting further research and discussion on
multimedia information technology enables interaction
effects of reminiscence therapy on elderly people with MCI in future.
and attracts subjects' attention or provides enjoyment.
In recent years, several studies applied multimedia information
• Results indicated that multimedia information technology
technology (MIT) to reminiscence therapy. Using MIT aimed at provid-
can improve cognitive function and quality of life among
ing health care to patients using mobile devices (eg, telephones,
elders with MCI. However, limited evidence can be used
computers, and televisions) to meet needs and to capture interest of
to support efficacy of MESSAGE communication strategy
patients. Based on MIT support for various reminiscence media, such
combined with GRT on elders with MCI.
type of technology can be summarized as sets of text, sound, graphics,
• Researchers must explore large‐scale and well‐designed
and multimedia album,14,15 daily assistance by videophone,16 music
randomized controlled trials to confirm effects of
game,17-19 computer interactive reminiscence and conversation aid
MESSAGE communication strategy combined with GRT
system,20,21 and other types. These studies showed that when
on elders with MCI in long‐term care facilities in China.
combined with reminiscence therapy, MIT encourages positive interactions between dementia patients and their caregivers and elicits verbal
reminiscence in patients,17-21 catches their attention and improves
to 9 subjects. Each subgroup followed the same intervention protocol.
psychological stability,15,16 guides and navigates patients for indepen-
Members of intervention group received 1‐ to 1.5‐hour session of GRT
dent living,14 and enriches reminiscence material by constructing a
once a week for 12 weeks. The control group included participants
20
database that includes clips video, photos, music, or other materials.
who did not receive any intervention measures.
Cognitive decline impairs memory and language skills, thus
interfering with effective communication.22 Researchers developed
2.1
|
Participants
various communication strategies, such as MESSAGE strategy,23,24
Advanced Innovative Internet‐Based Communication Education
strategy,25 and Internet‐Based Savvy Caregiver program26 for (in)formal dementia caregivers. These strategies not only improve care
quality of caregivers but also increase effective communication
between patients and caregivers. The present study used 7 basic
frameworks of MESSAGE communication strategy as models to guide
23
development and implementation of GRT programs.
To our knowledge, no study concurrently evaluated combination
of MESSAGE communication strategy and GRT for Chinese elderly
people with MCI. Our work was based on specific communication education strategy and reminiscence therapy program of a previous study,
Inclusion criteria included willingness to participate in the study and
elderly subjects (age > 60 y) with MCI. Based on Petersen's criteria,
inclusion criteria consisted of the following: (1) report of subjective
memory complaint (≥1 y); (2) preserved general intellectual functioning
(as estimated by Mini‐Mental State Examination [MMSE]); (3) demonstration of memory impairment by cognitive testing (as estimated by
Beijing version of the Montreal Cognitive Assessment [MoCA‐BJ]);
(4) intact ability to perform daily living activities (activity daily living
scale score < 22); and (5) diagnosis of MCI. Exclusion criteria included
unstable cardiac diseases, significant cerebrovascular diseases, serious
hearing problems, and serious vision problems.
which included elderly people with MCI in long‐term care facilities in
Changchun, Jilin Province. This method is guided by MESSAGE com-
2.2
munication strategy to explore effects of GRT on Chinese traits and
Based on the following formula (power: 80%; α: .05) and data of similar
low‐level MIT on elderly people with MCI; it not only broadens chan-
study conducted by Wang,27 sample size totaled 30 in each group.
|
Sample
nels of reminiscence therapy but also serves as reference for MIT in
application of reminiscence therapy or other nursing care intervention.
n1 ¼ n2 ¼
2
|
2
2× μα þ μβ σ2
δ2
METHODS
This work is a nonrandomized controlled study conducted in long‐term
2.3
|
Assessments
care facilities in Changchun, the capital of Jilin Province, China. The
Primary outcomes of this study included scores on MMSE, MoCA‐BJ,
researcher was selected totals of 30 elderly people according to room
and Short‐Form 36 Health Survey (SF‐36) assessment. Scores on
numbers ahead as intervention group, whereas others were selected as
MoCA‐BJ and SF‐36 served as bases for both secondary and third out-
control group (totals of 3 buildings). For the intervention group, 4 sub-
comes. Cognitive function and quality of life were assessed at baseline
groups were formed sequentially, with each subgroup consisting of 7
and after 6 and 12 weeks.
ZHANG
615
ET AL.
Mini‐Mental State Examination was used to assess subjects for
festival, and cooking, all of which are features of Chinese era (1930‐)
cognitive changes28 and modified based on sociocultural and language
and are national characteristics (Table 1). We also noted that participants
characteristics of Chinese population. Cut‐off scores were over 17 for
failed to provide related personal photos. However, the elderly people
illiterate subjects, over 20 for those with 1 to 5 years of schooling, and
commented that they also adored public pictures with sense of history
over 24 for those with more than 5 years of schooling, indicating
as such things trigger past memories. Considering sociocultural
general normal cognitive function.29
background of China, we decided not to include the marriage theme.
Beijing version of the Montreal Cognitive Assessment was
However, elderly people similarly look forward to true love. Thus, we
translated by Wang and Xie (www.mocatest.org). It is widely studied
placed marriage certificates, food stamps at different places and times,
and was confirmed with satisfactory reliability and validity when
varieties of kerosene lamps, and other generic photos obtained from
applied on local elderly populations.30-32 Zhang and Liu33 explored
the Internet into the theme of electronic album. We placed toys and school
application of MoCA‐BJ in screening of MCI in elderly people living
time in childhood theme. Meanwhile, we excluded the theme of life story
in nursing homes in Guangzhou. Cut‐off scores of 15 to 24 on
book, which is widely used for individual reminiscence therapy. Finally,
MoCA‐BJ indicate MCI (without reports on educational bias). The
we discussed feasibility of each theme with a nursing and geriatrics
present study adopted a similar cut‐off score.
specialist who selected 12 themes (see Table 2).
In comparison with MMSE, MoCA performs better in screening
MCI and sensitivity.29 According to the National Institute of Neurolog-
2.4.2
ical Disorders and Stroke‐Canadian Stroke, MoCA is advantageous in
Based on 12 themes, we redesigned the theme content for interven-
diagnosing vascular cognitive impairment.34 This method also aids in
tion group, and we used Smith's MESSAGE communication strategy
confirmation of MCI diagnosis as recommended by the Third Canadian
as model, properly adjusted the framework of MESSAGE communica-
Consensus Conference on the Diagnosis and Treatment of Dementia.35
tion strategy (Table 3). Our study also used reminiscence elements
To measure quality of life, this study used the Chinese (mainland)
(generic photos and suitable theme‐content video materials) suitable
version of SF‐36 as developed by experts of Sun Yat‐Sen University of
for Chinese elderly people. To engage interaction and to provide
Medical Sciences, China. Short‐Form 36 Health Survey contains 36 items
enjoyment, low‐level MIT was used in redesigning theme content.
(9 scales). Responses were made on 2‐ to 6‐point Likert scale except for
Each individual features a different life experience, and individual dif-
that of reported health transition. Raw score of each eight‐SF‐36 scale
ferences are large. Thus, the present study did not create relevant
|
Redesigning of theme content
was derived by summing item scores and converting the numbers to
generic video of these 3 themes: work experience, my ideals, and my
values ranging from 0 to 100. High scores indicate high quality of life.
achievement. As self‐introduction and memories of good times only
represented the beginning and end of group reminiscence activity,
2.4
2.4.1
we also did not create any relevant generic video for these themes.
GRT program
|
|
Theme design
Related research at home and abroad was first consulted and considered
2.5
|
Statistical analyses
16 themes (old picture, old films, traditional Chinese opera, food stamps,
Collected data were analyzed using SPSS software, Chinese version
music, childhood, toys, traditional festival, school time, cooking, my ideals,
17.0. Data features were described using statistical descriptive tests,
marriage, my achievement, life story book, work experience, and family).
such as mean, standard deviation, and percentage. We analyzed inter-
When screening for related topics, 10 individuals (age > 60 y; 5 male
action group × time of repeated measures of analysis of variance with
individuals, 5 female individuals) were selected through convenient
groups as between‐subject factor and time of assessment as within‐
sampling in face‐to‐face survey interviews (10 min). Interviews mainly
subject factor. We reported mean difference of within‐group and its
focused on music, old films, old picture, marriage, childhood, traditional
95% confidence interval.
TABLE 1
Interview content
Type
Interview Questions
Aim
Music
Talk about Chinese opera or songs that you like
To determine types of music preferred by elderlies
Old films
Talk about films that you have seen
To find video clips that cause emotional resonance
with elderlies
Old photos
Share your individual photos and tell their story
To determine whether elderlies can provide individual
photos that they associate with good memories or
have profound impact on them
Marriage
Talk about the story of you and your wife
To determine whether marriage can be a separate
activity theme
Childhood
Share your childhood with us
To determine whether toys (or games) and school time
can be integrated into a theme
Traditional festival
Talk about your views on traditional Chinese festival
To determine whether the theme of traditional festival
can stimulate good memories of elderlies
Cooking
Talk about meals that you like to eat or you often cook
To determine whether elderlies are interested in the
theme of cooking
Themes
Self‐introduction
Music
Old films
Electronic album
Childhood
Traditional festival
Cooking
Family
Work experience
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Group reminiscence activity program
Arrangement
TABLE 2
1. Talk about work experience you have
accumulated
2. Talk about your personal understanding
of your work
1. Play relevant generic video (5 min)
2. Briefly introduce family situations
3. Share happy memories with family
1. Play relevant generic video (5 min)
2. Memories of childhood and delicious foods
3. Share home‐cooked meals or soups that
you like
4. Talk about meals that you often cook
1. Play relevant generic video (5 min)
2. Take about traditional festivals that you
like
3. Share interesting things that you do or
observe during festivals
4. Discuss how you celebrate your favorite
festivals
1. Play relevant generic video (5 min)
2. Share good times of childhood (around
games/toys/school times)
1. Play electronic album (about 10 min)
2. Share stories behind photos
1. Play film clips (40 min)
2. Tell about the feeling and memory of films
3. Share films that like elderlies watching and
reasons for watching them
1. Use the song machine to play classic songs
2. Share the story behind these songs
3. Encourage singing songs that elderlies like
1. Self‐introduction
2. hobbies and interests of elderly people
Content
Warm Animation video (Home Memory) was
split with Studio by Ulead Video and played
in the projection screen.
Digital photos of characteristic foods of the
northeastern region of China were selected
and edited (approaching week 4). Then clips
of soft music accompaniment (Song of brook)
were inserted as background music into a series
of relevant digital photos.
Spring Festival documentary of China Central
Television was split by Ulead Video Studio,
and we inserted Spring Festival couplets and
paper‐cuts into the end of this clip video.
Meanwhile, clips of soft music accompaniment
(Spring Festival Overture) were played consistently
in the background as video soundtrack.
The sand painting video (Recalling Our Lost
Childhood) was split by Ulead Video Studio,
and all kinds of childhood memories were
presented with scrolling marquee at the end
of clipped video. Then, clips of soft music
accompaniment (Children) were played in the
background.
Brightness and size of digital photos' (generic
photos of the 1930s to 1960s) adjusted by
Photoshop; images were blown up and
annotated by Ulead Video Studio or Windows
Media Player. Then, clips of soft music
accompaniment (Where Are All The Time)
were inserted as background music into a
series of relevant digital photos.
Two films were split by Ulead Video Studio
and merged, and name and age of film were
introduced by word annotation. Then, we
added pictures of related themes and inserted
dynamic image that displayed countdown
timer before the beginning of the video.
When projectors and song selection system
were connected, four downloaded classical
songs were played, and corresponding
lyrics also appeared in the projection screen.
Application of Technology
(Continues)
3. To stimulate good memories of elderlies
and to share their happiness with one
another;
2. Encourage elderlies to participate in activity
and promote interaction between them;
1. To stimulate vision and auditory senses
of elderlies and add fun to the activity;
To build trust
Aim
616
ZHANG
ET AL.
617
ET AL.
To adopt suggestions, improve program
activities, and remain calm and optimistic
toward life.
Application of Technology
Aim
4. To encourage self‐identity and self‐worth.
TABLE 3
MESSAGE communication strategy
Term
Content
M—Maximize attention
1. Attract attention;
2. Maintain eye contact;
3. Limit distractions
E—Expression and body language
1. Relaxed and calm;
2. Shows interests
S—Keep it Simple
1. Short, simple, familiar;
2. Give clear choices
S—Support their conversation
1.
2.
3.
4.
A—Assist with Aids
1. Electronic album;
2. Five relevant generic videos;
3. Music
G—Get their message
1. Listen, watch, and actively
work out;
2. Check behavior and nonverbal
message
E—Encourage and Engage in
conversation
1. Interesting, fixed topics;
2. Talk about researchers, other
elders
3
3.1
Provide sufficient time;
Assist with finding words;
Repeat then rephrase;
Remind of the topic
RESULTS
|
|
Characteristics of respondents
Table 4 summarizes baseline characteristics of respondents. A total of
53 subjects completed all sessions of the study. Study protocol was
not completed by 7 (11.7%) subjects: 4 from intervention group
(2 moved away, 1 was sick, and 1 went home) and 3 from control group
1. Summary of activities
2. Talk about activity themes that you like most
3. Talk about your feelings and suggestions
for the activity
4. Suggestions for young people
Talk about your sense of accomplishment and
comforting things in your life
1. Dreams of youth
2. Talk about your efforts to achieve your ideals
3. Talk about your sentiment
Content
(1 went to travel with children, and 2 became sick). No significant
difference was observed in age, gender, marital status, educational
level, profession, religious belief, drinking situation, smoking status,
and disease situation of intervention and control groups (P > .05); it
pointed that subjects of the 2 groups were homogeneous.
Table 5 presents total MoCA score and scores for 7 cognitive
domains of MoCA. Total MoCA indicated significant effects of time,
group, and group × time interaction. For visuospatial/executive function, naming, delayed memory, and orientation, significant effects of
time were observed, but group or group × time interaction did not yield
significant effects. Time and group × time interaction significantly
affected visuospatial/executive function, naming, and language. For
visuospatial/executive function and naming, significant improvements
were observed in control group at 12 weeks. Intervention and control
Memories of good times
My achievement
My ideals
tion. For delayed memory, both groups showed most significant
improvements at 6 and 12 weeks. Significant advancements in language were observed for the intervention group at 6 weeks.
For intervention and control groups, Table 6 shows changes in
various items on health‐related quality of life based on SF‐36 at baseline and 6 and 12 weeks. Time and group × time interaction
significantly affected general health, vitality, social functioning, role‐
emotional, and mental health. However, social function did not
Week 12
Week 11
significantly affect observed groups. For role‐physical, only time
Week 10
Arrangement
(Continued)
Themes
groups did not show enhancement in attention, abstract, and orienta-
TABLE 2
ZHANG
caused significant effects. For role‐physical, social function, and mental
health, both groups showed significant increases at 6 and 12 weeks.
The intervention group exhibited significant enhancement in general
618
ZHANG
TABLE 4
Characteristics of participants at study inclusion
ET AL.
health, role‐emotional, and vitality at 6 and 12 weeks. Significant
improvements in bodily pain were observed for each group at 6 weeks
Characteristics
Intervention
(n = 26)
Control
(n = 27)
P‐value
but not at 12 weeks. For physical functioning, the intervention group
Age (mean ± SD)
81.19 ± 5.48
80.78 ± 6.80
.81
showed slightly significant increase after 6 weeks.
60‐69
1 (3.9)
3 (11.1)
70‐79
7 (26.9)
5 (18.5)
80‐89
18 (69.2)
19 (70.4)
Female sex, n (%)
21 (80.8)
17 (63.0)
Illiterate
4 (15.4)
1 (3.7)
Primary school
3 (11.5)
4 (14.8)
Secondary school
4 (15.4)
3 (11.1)
We confirmed that GRT improved cognitive function of patients with
High school or
technical secondary
4 (15.4)
3 (11.1)
mental dysfunctions. In the present work, MESSAGE communication
11 (42.3)
16 (59.3)
Education, n (%)
College or above
4
|
DISCUSSION
.15
.54
4.1 | Effect of GRT on cognitive function of elderly
people with MCI
strategy was used as prototype to increase effective communication
Marital status, n (%)
Single
.51
between elderly people with MCI and researchers and to reduce
.26
negative effects of ineffective communication on intervention effect.
1 (3.8)
0 (0.0)
Married
10 (38.5)
15 (55.6)
and evaluation, a 12‐theme program of group reminiscence activities
Divorced
2 (7.7)
0 (0.0)
was developed for each theme to stimulate life experience and good
13 (50.0)
12 (44.4)
Widow
Occupational status, n (%)
Original GRT program was also used as basis. Finally, through screening
memories in the intervention group. The following conclusion was then
.23
drawn: A 12‐theme program of group reminiscence can actively improve
Farmer
0 (0.0)
4 (14.8)
Worker
9 (34.6)
4 (14.8)
Technicians
2 (7.7)
1 (3.7)
MIT to individual reminiscence therapy or GRT. Significant interven-
Functionary
4 (15.4)
4 (14.8)
tion effect was also observed in language and memory function of
Teacher
5 (19.2)
5 (18.5)
people with dementia.36,37 The present study used Ulead Video Studio
Other
6 (23.1)
9 (33.4)
Religion, n (%)
None
cognitive function, especially delayed memory, of elderly people.
With continuous its development researchers gradually applied
and Windows Media Player to edit digital photos with special signifi.61
cance and time characteristics. Soft background music was then added
23 (88.5)
23 (85.2)
to the electronic album. Existing activities were also added in line with
Buddhism
3 (11.5)
3 (11.1)
themes of existing complete videos, such as the old films Five Golden
Christian
0 (0.0)
1 (3.7)
Flower and Landmine War, the documentary Spring Festival, and other
23 (88.5)
22 (81.5)
Sometimes
2 (7.7)
5 (18.5)
Often
1 (3.8)
0 (0.0)
Drinking status, n (%)
Never
clips. Video clips were then integrated and edited using story to
Smoking status, n (%)
Never
.32
stimulate intervention of episodic memories. When using music as
theme of activities, machine was required. The songs Let's Sway Twin
Oars, Shooting Back, and others were played in the projection screen.
.37
Lyrics were prepared, and tracks were played, allowing participants
24 (92.4)
24 (88.9)
to sing together. As a result, improvement was noted in recall ability
Sometimes
1 (3.8)
0 (0.0)
of familiar songs and language skills of intervention group members
Often
1 (3.8)
4 (11.1)
Disease status, n (%)
Without
alone or with other subgroups and subgroup members, thus facilitating
.86
language communication and memory function among participants.
5 (19.2)
5 (18.5)
Results of this study showed that increase in delayed memory may
With one kind of
disease
15 (57.7)
14 (51.9)
benefit from MoCA scale of 5 words in 3 repetitive memories gener-
2 or more than 2
kinds of diseases
6 (23.1)
8 (29.6)
Genetic history, n (%)
ated by exercise. A longitudinal study38 showed that twice‐repeated
practice effects affected memory of patients with MCI; through
.58
story‐memory and list‐learning tests, one study39 also showed signifi-
25 (96.2)
25 (94.3)
cant effects of practice on delayed recall of MCI patients. Thus, based
Dementia
0 (0.0)
0 (0.0)
on practice effects and tolerance of elderly people to continuous
Other
1 (3.8)
2 (5.7)
intervention plan, group reminiscence program should be adjusted
Without
ADL (mean ± SD)
15.27 ± 2.13
15.70 ± 2.42
.96
and improved in future studies. This finding disagrees with decline in
MMSE (mean ± SD)
25.73 ± 2.38
25.81 ± 2.51
.90
orientation scores among elderly people with MCI in the 2 groups.
Abbreviations: ADL, activities of daily living; MMSE, Mini‐Mental State
Examination.
Possibly, in long‐term care facilities, admitted elderly people claim that
they lack time perception. With increased degree of cognitive impair-
***P < .001,
ment, time‐directed decline serves as sensitive indicator for cognitive
**P < .01, and.
function of patients.40,41 Therefore, early intervention is needed by
*P < .05.
elderly people at MCI stage to strengthen training in time orientation.
Intervention
Control
t/Z
P
Intervention
Control
Z
P
Intervention
Control
Z
P
Intervention
Control
Z
P
Intervention
Control
Z
P
Intervention
Control
t/Z
P
Intervention
Control
Z
P
Visuospatial/
Executive
function
Naming
Attention
Language
Abstract
Delayed
memory
Orientation
5.92 ± 0.27
5.59 ± 0.69
−2.09
0.037*
1.65 ± 1.44
1.41 ± 1.08
−0.854
0.393
0.77 ± 0.77
0.74 ± 0.66
−0.029
0.977
1.69 ± 0.62
1.63 ± 0.57
−0.103
0.918
4.50 ± 1.33
4.48 ± 1.16
−0.184
0.854
2.54 ± 0.65
2.74 ± 0.53
−1.285
0.199
2.35 ± 1.23
2.81 ± 1.11
−1.456
0.151
19.42 ± 2.56
19.41 ± 2.21
0.024
0.981
Baseline
Mean ± SD
5.77 ± 0.51
5.41 ± 0.75
−2.004
0.045*
2.04 ± 1.11
1.78 ± 1.05
0.877
0.384
0.69 ± 0.68
0.74 ± 0.59
−0.388
0.698
2.04 ± 0.66
1.59 ± 0.64
2.399
0.016*
4.46 ± 1.27
4.15 ± 1.06
−1.044
0.279
2.81 ± 0.40
2.74 ± 0.53
−0.328
0.743
2.96 ± 1.08
2.67 ± 1.41
−0.982
0.326
20.77 ± 2.36
19.19 ± 2.27
2.493
0.016*
6 wk
5.69 ± 0.55
5.15 ± 0.82
−2.598
0.009**
2.77 ± 0.99
2.04 ± 0.98
2.703
0.009**
0.73 ± 0.72
0.56 ± 0.75
−1.009
0.313
1.92 ± 0.69
1.56 ± 0.64
−1.836
0.066
4.42 ± 0.90
4.04 ± 1.13
−1.185
0.236
2.81 ± 0.40
2.85 ± 0.53
−0.615
0.539
3.08 ± 1.09
2.96 ± 1.19
−0.509
0.611
21.38 ± 2.00
19.22 ± 2.19
3.755
0.000***
12 wk
*P < .05.
**P < .01, and
***P < .001,
Abbreviations: CI, confidence interval; MoCA = the Montreal Cognitive Assessment.
Intervention
Control
t
P
Group
Effects of intervention on cognitive function
Total MoCA
score
Outcome
Variable
TABLE 5
.086
.076
.212
.363
−0.154 (−0.401, 0.094)
−0.185 (−0.596, 0.226)
.425
1.000
−0.077 (−0.272, 0.118)
0.000 (−0.155, 0.155)
0.385 (−0.059, 0.828)
0.370 (−0.042, 0.783)
.059
.814
.832
.047*
−0.038 (−0.408, 0.331)
−0.333 (−0.662, −0.004)
0.346 (−0.014, 0.706)
−0.037 (−0.357, 0.282)
.016*
…
.000***
.294
.000***
.477
0.269 (0.054, 0.485)
0.000 (0.000, 0.000)
0.615 (0.311, 0.919)
−0.148 (−0.432, 0.136)
1.346 (0.681, 2.012)
−0.222 (−0.856, 0.411)
P‐value
Mean Change from Baseline (95% CI)
6 wk
−0.231 (−0.404, −0.057)
−0.444 (−0.860, −0.029)
1.115 (0.417, 1.813)
0.630 (0.175, 1.084)
−0.038 (−0.252, 0.175)
−0.185 (−0.376, 0.006)
0.231 (−0.118, 0.579)
−0.074 (−0.402, 0.254)
−0.077 (−0.488, 0.334)
−0.444 (−0.860, −0.029)
0.269 (0.087, 0.452)
0.111 (−0.016, 0.238)
0.731 (0.417, 1.045)
0.148 (−0.136, 0.432)
1.962 (1.341,2.582)
−0.185 (−0.700, 0.330)
12 wk
.011*
.037*
.003**
.008**
.713
.057
.185
.646
.703
.037*
.016*
.083
.000***
.294
.000***
.466
P‐value
0.018*
0.000***
0.256
0.414
0.146
0.001**
0.000***
0.000***
Time
Significant
0.000***
0.075
0.768
0.012*
0.387
0.642
0.948
0.035*
Group
0.613
0.304
0.256
0.223
0.361
0.036*
0.001**
0.000***
Time × Group
ZHANG
ET AL.
619
Intervention
Control
t/Z
P
Intervention
Control
Z
P
Intervention
Control
Z
P
Intervention
Control
Z
P
Intervention
Control
Z
P
Intervention
Control
t/Z
P
Intervention
Control
Z
P
Mental health
Role‐emotional
Vitality
Social
functioning
Role‐physical
Physical
functioning
Bodily pain
*P < .05.
**P < .01, and
***P < .001,
Abbreviation: CI, confidence interval.
Intervention
Control
t
P
Group
68.38 ± 24.29
73.74 ± 27.43
−0.751
0.456
63.65 ± 10.64
60.93 ± 11.44
0.898
0.373
30.77 ± 35.57
32.41 ± 35.23
−0.168
0.867
30.29 ± 14.65
41.20 ± 17.95
−2.42
0.019*
40.96 ± 10.20
42.59 ± 11.21
−0.553
0.582
38.46 ± 32.24
40.74 ± 31.12
−0.262
0.794
52.65 ± 10.07
55.04 ± 9.47
−0.888
0.379
38.54 ± 21.31
32.96 ± 15.32
1.097
0.278
Baseline
Mean ± SD
Effects of intervention on quality of life
General health
Outcome
Variable
TABLE 6
72.12 ± 17.51
76.07 ± 20.09
−0.763
0.449
65.19 ± 9.75
60.74 ± 8.05
1.816
0.075
51.92 ± 22.28
43.52 ± 21.48
1.399
0.168
46.63 ± 15.23
44.91 ± 13.54
0.437
0.664
49.81 ± 11.36
42.78 ± 8.47
2.561
0.013*
55.13 ± 24.84
41.98 ± 25.48
1.902
0.063
66.00 ± 7.69
57.19 ± 7.75
4.154
0.000***
50.31 ± 20.23
36.85 ± 14.27
2.806
0.007**
6 wk
68.88 ± 18.00
73.00 ± 17.99
−0.832
0.409
65.19 ± 10.34
61.30 ± 9.77
1.411
0.164
57.69 ± 22.10
48.15 ± 21.85
1.581
0.120
53.84 ± 14.48
45.83 ± 16.26
1.892
0.064
55.19 ± 9.64
41.30 ± 11.65
4.721
0.000***
65.39 ± 24.00
41.97 ± 31.48
3.036
0.004**
73.69 ± 6.71
62.44 ± 10.88
4.550
0.000***
53.27 ± 17.86
33.81 ± 13.54
4.479
0.000***
12 wk
3.731 (−6.291, 13.753)
2.333 (−9.369, 14.036)
1.538 (−1.578, 4.655)
−0.185 (−3.925, 3.555)
21.154 (9.840, 32.468)
11.111 (−0.949, 23.172)
16.346 (8.297, 24.395)
3.704 (−4.153, 11.560)
8.846 (4.410, 13.282)
0.185 (−3.712, 4.083)
16.668 (3.894, 29.441)
1.235 (−11.686, 14.156)
13.346 (10.719, 15.974)
2.148 (−2.428, 6.742)
11.769 (6.023, 17.516)
3.889 (−1.549, 9.327)
.450
.685
.319
.920
.001**
.069
.000***
.341
.000***
.923
.013*
.846
.000***
.343
.000***
.154
P‐value
Mean Change from Baseline (95%CI)
6 wk
0.500 (−9.779, 10.779)
−0.741 (−14.223, 12.741)
1.538 (−2.241, 5.318)
0.370 (−3.096, 3.837)
26.923 (11.300, 42.546)
15.741 (3.738, 27.743)
23.558 (15.694, 31.422)
4.630 (−3.951, 13.211)
14.231 (10.084, 18.377)
1.296 (−6.960, 4.367)
26.925 (10.317, 45.533)
1.234 (−15.717, 18.186)
21.038 (17.301, 24.776)
7.407 (0.988, 13.827)
14.731 (8.511, 20.951)
0.852 (−3.775, 5.479)
12 wk
.921
.911
.410
.828
.002**
.012*
.000***
.278
.000***
.642
.003**
.882
.000***
.025*
.000***
.708
P‐value
0.634
0.688
0.000***
0.000***
0.000***
0.020*
0.000***
0.000***
Time
Significant
0.260
0.135
0.361
0.900
0.006**
0.044*
0.001**
0.004**
Group
0.885
0.741
0.295
0.001**
0.000***
0.038*
0.000***
0.001**
Time × Group
620
ZHANG
ET AL.
ZHANG
621
ET AL.
In future studies, intervention should be added to stimulate concept of
5
|
CO NC LUSIO N
time for elderly people with MCI delay downward trend in orientation,
and improve their cognitive function.
We must identify suitable interventions and the most effective
methods of improving cognitive function and quality of life in elderly
population. According to results of the present study, a 12‐week period
4.2 | Effects of GRT on quality of life of elderly
people with MCI
(consisting of 12 group reminiscence sessions) of intervention plays an
active role in cognitive function (especially delayed memory) and quality of life (general health, mental health, role‐emotional, and vitality) in
Quality of life of elderly people and different cognitive impairments show
elderly people with MCI. To compare MESSAGE communication strat-
significant differences.42 Improved in cognitive function results in higher
egy, MIT, and combination of 2 effects of reminiscence therapy, future
quality of life.43 The present study shows that intervention improved
studies should include large samples of 2 or more randomized con-
cognitive function in elderly people with MCI, thus improving their
trolled trials. We also communicated knowledge and skills training to
quality of life. Group reminiscence activities also promote interaction
researchers or caregivers of people with MCI for their benefit.
between elderly people, establish good social support system44 that
reduces solitude and loneliness generated by sense of self‐conscious
fatigue, and increase their vitality. In this study, elderly people with
MCI were provided with group activities aimed at promoting life quality.
Communication between dementia and caregivers can be promoted by MESSAGE communication strategy,23,24 thereby improving
quality of life of dementia patients. This study not only used MESSAGE
communication strategies to redesign the content of GRT program but
ACKNOWLEDGEMENTS
The authors would like to thank the participants and their families,
caregiving staffs, and long‐term care facility managers who took part
in the study. We also thank the postgraduate students (RN) who were
involved and communicated with people with MCI. Finally, we express
our gratitude to the Consultative Committee and Graduate Innovation
Fund of Jilin University for the study.
also implemented the program based on its basic framework to promote (non)verbal communication between researchers and elderly
people with MCI. Encouragement of researchers also allowed creation
of activities with pleasant and relaxed atmosphere. Such condition
CONFLIC T OF IN TE RE ST
None declared.
aided elderly people with MCI to share personal experiences or good
memories related to theme of activities. To aid intervention, the elderly
SOURCE OF FUNDING
people must possess positive attitude to live lives in state of pension
Supported by the Graduate Innovation Fund of Jilin University—
agencies and to engage in activities for self‐identity, allowing success-
Project 2016224.
ful physiological and psychological interventions to a certain extent.
Thus, elderly people with MCI were guided with positive and optimistic
attitude to help them adapt in long‐term care facilities.
This study used zooming effect and annotation for a self‐made
electronic album and relevant generic video of 5 themes to enrich
activity content. Thus, participants felt calm and happy because of
various familiar scenes that guided them during language reminiscence,
resulting in easier expression and release of emotions in the activity,
agreeing with the findings of Hamada et al.14 Meanwhile, when
watching electronic album and relevant generic videos, the elderly
people continually communicated their views or asked us about what
was shown on the screen. Finally, the elderly people discussed their
interests and asked us to add more content or extend screening,
making the whole activity more active and easy and promoting interaction among elderly people with MCI and with researchers.
This study also acknowledges the following limitations. First, owing
to schedule of rest and recreational activities, this study featured nonuniform time of data collection and evaluation. Weaker intervention effects
ORCID
Huan‐huan Zhang
http://orcid.org/0000-0003-4491-9935
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How to cite this article: Zhang H, Liu P, Ying J, et al. Evaluation of MESSAGE communication strategy combined with
group reminiscence therapy on elders with mild cognitive
impairment in long‐term care facilities. Int J Geriatr Psychiatry.
2018;33:613–622. https://doi.org/10.1002/gps.4822