Page 1 of 3

Applications in practice

In this section you will explore the idea that by listening to older people’s recollections of their past lives you can help them in the present. This is essentially putting ‘life story’ into practice - through the biographical approach to working with individuals.

Your main task as you work through this section of the learning object is therefore the practical one of noting down reasons and evidence which enable you to answer the following question:

How can the biographical approach and reminiscence be of practical use in work with older people with mental health issues?

Introduction

The biographical approach is one method of understanding later life. It is based on the following assumptions:

  • Each individual has a unique experience of ageing which they carry with them into later life.
  • What we call ‘old age’ is not something which can ne separated from the rest of life.
  • What happens in later life is shaped by the experiences and events of the past and the meanings derived from them.
  • From these, the older person will have developed their own way of coping with the world and with the major events and relationships which mark the course of an adult life.

Benefits for older people with mental health problems

The biographical approach can reveal how self-esteem and mental well-being in later life may depend on maintaining continuity with previous relationships, interests and values.

In developing a care plan for an older person with depression, for example, it may be possible to uncover the sources of life stresses which have contributed to their present condition as well as those interests, strengths and achievements which were once a source of self-esteem.

Such knowledge can assist communication and influence decisions made about the services or care most suited to an individual's needs.

Of course dementia may gradually cause people's life stories to fade in their minds.

The earlier sharing of a life history in dementia care can reinforce positive carer attitudes, however, such as respect, understanding and acceptance.

Care plans and the quality of staff-user interactions can be influenced by the deeper knowledge of a person which biographical knowledge brings. This may continue to enhance care even in the later stages of the illness when communication is severely reduced (Mills, 1997).

An example from practice

The biographical approach in research or practice consists essentially of one or more interviews in which the older person is encouraged to talk about their past life so that their current needs and preoccupations can be better understood(Gearing and Dant, 1990).

What is most important is not simply collecting the ‘facts’ of a life, but uncovering the meanings events have for that individual and how these have shaped present concerns and needs. This matters more than accuracy about particulars.

Research has demonstrated that a biographical approach can be effective in increasing the quality of assessments for community care (Gearing and Coleman, 1996).

Read the case study of Mr Allen which relates the application of the biographical approach by a social worker. As you listen think about the practical use that this approach can be in practice.

Mr. Allen had refused help several times when he was referred to the social worker. Her informal, non-interrogative, listening approach and encouragement to talk about his life, quickly seemed to gain his confidence, revealing much about his earlier life and employment as an insurance agent.

Mr. Allen showed considerable uncertainty of recall about specific events, but he talked about losing his wife many years earlier and how he had brought up his son single-handed. He revealed his longstanding loneliness saying that 'there was nothing to come home for'. However, he claimed to do things he had always enjoyed, like walking, betting on the dogs, and calling into the Soldiers and Sailors Club most lunch times.

But his home showed signs of having been neglected for some time; not only was it untidy but littered with remains of food. According to Mr. Allen he was managing, but the social worker doubted how well and regularly he ate. If asked what he had eaten that day, he would look at the table for clues and clearly there were occasions when he could not remember whether he had eaten at all. He habitually wrote notes to himself as if to prop up his failing memory. Mostly he sat watching television and smoking cigarettes. A lifetime of heavy smoking had taken its toll in the form of chronic bronchitis and constant breathlessness.

It transpired that one of the receptionists at the general practice to which the social worker was attached had known Mr. Allen and his family for years. Mr. Allen's wife had in fact died more recently than he remembered. His son had left home some time before this. His visits to different places were now the exception rather than the rule: the barman at the Soldiers and Sailors confirmed that Mr. Allen had not been there for some time. On the occasions he had been seen there, he would forget he had paid for a drink, returning to the bar more than once to offer money.

The social worker's use of the biographical approach helped her to share Mr. Allen's life experiences and to better understand his mental health needs. It became clear that he had suffered a marked loss of short-term memory and, when questioned, relied on his more accurate long-term memory. Consequently, the description he gave of his current circumstances only gave an accurate picture of how he had once managed, not of his present lifestyle.

Without a biographical assessment it seems unlikely that Mr. Allen would have received the kind of help he needed and found acceptable. It helped the social worker to get to know Mr. Allen over time and in a way which enabled him to relax and give his trust. It helped in the assessment of his mental health needs and, this, in turn helped other workers who were later involved in his care. Through her knowledge of his past life, the social worker learned about Mr. Allen's relationship with his neighbour, and she was able to revive a family friendship which had faded over the years. This also led to the help provided by neighbour's daughter-in-law, something which was acceptable to Mr. Allen and maintained him happily in his own home for several months until his physical health deteriorated to the point when he entered a nursing home where he spent the last weeks of his life.

Find out more information

If you would like to find out more about the biographical approach, a good starting point is the web-site of the Centre for Ageing and Biographical Studies (CABS) at the Open University (www.open.ac.uk/hsc/researchCABS.htm). CABS was established as a centre for gerontology and biographical research which aims to develop links between theory, research, policy and practice. You will find information about their current and recent activities which includes seminars, a newsletter and details of research projects which include topics such as ageism and images of age, age discrimination, and birthdays. The web-site also gives useful links with other research and practice sites.

Introduction

Reminiscence work can be defined as a range of activities stretching from informal one-to-one sessions in which memories play a part, to more formally organised group activities with a programme (Bornat et al.,1999). A common element in all reminiscing is the recollection of a life story ( Coleman, 1994)

There is no doubt that in their later years many people reflect more on the value and meaning of the life they have lived. Reminiscence is now recognised as having an adaptive value: it can promote better health in old age, at least for some (Coleman, 1986).

There is now an extensive research and practice literature documenting ways in which staff working in domiciliary care, day care, and residential homes have used reminiscence work with older people (Bornat et al., 1999).

Benefits for older people with mental health problems

The main benefits of reminiscence work are:

  • It uses existing (remaining) capacities and skills.
  • It enables individuals to review their lives.
  • It affirms identity.
  • It communicates knowledge and life experience to another generation.

A major benefit for care staff can be the discovery of aspects of a person’s life of which they would otherwise have remained unaware, something which can enhance a care plan or – in the case of particular interests or strong likes and dislikes – be built into a daily routine or regular activity.

Reminiscence is not a universal panacea, however. Some people see no point in discussing their past. For others this activity evokes painful episodes which the do not wish to dwell upon (Coleman, 1986). For this reason freedom of choice over whether to participate is important.

Application in Practice

Although reminiscence work can be successfully undertaken with groups of people who have dementia, Gibson's research suggests that it is most effective when implemented on a one-to-one basis.

Attitudes began to change when, in 1963, Robert Butler, an American psychologist, published The Life Review: An Interpretation of Reminiscence in the Aged.

Butler, who had been influenced by Erikson, argued that:

  • The life review is a normal universal process.
  • It can be a healthy response to various types of crisis encountered as we age.

This 'gave permission' to social workers, nurses, occupational therapists and others to use reminiscence as a therapeutic tool which may enhance feelings of self-worth among some older people.

Butler, who had been influenced by Erikson, argued that:

  • The life review is a normal universal process
  • It can be a healthy response to various types of crisis encountered as we age.

This 'gave permission' to social workers, nurses, occupational therapists and others to use reminiscence as a therapeutic tool which may enhance feelings of self-worth among some older people.

There is now an extensive research and practice literature documenting ways in which staff working in domiciliary care, day care, and residential homes have used reminiscence work with older people (Bornat et al., 1999)

Reminiscence work takes place in different settings: hospitals, care homes, day centres and clubs.

It makes use of a variety of materials and techniques to evoke memories of the past:

  • specific questions
  • memory cues such as photographs and artefacts of the past
  • music
  • films
  • texture, taste, and sounds (particularly used with people with dementia)

Life books, scrapbooks or memory boxes comprising photographs and small mementoes of a person's past life have been compiled by relatives. These can provide a talking point for staff and service user, and reveal an extra dimension of a person to care staff.

Reminiscence and Dementia

People with dementia may reach a point where they can no longer communicate all or most of their story to a listener.

Kitwood (1998) argues that it is here that an act of empathy and imagination is required by a listener in putting themselves in the position of the person with dementia. Often a story can be pieced together, from fragments and with information from relatives. Mistakes and misunderstandings will occur and one should recognise that the story may change as new information comes to light, but there is value in helping someone to hold their narrative together for as long as they can.

Gibson's research suggests that the most effective reminiscence work undertaken with people with dementia will be undertaken on a one-to-one (rather than group) basis. It needs careful planning and selection of participants and a specific focus.

Although it is not possible to halt or reverse the illness, reminiscence can have some positive benefits, including:

  • helping family carers sustain their caring
  • helping staff challenge their own attitudes and mistaken assumptions about residents and service users
  • increased job satisfaction
  • appearing to reduce restlessness and agitation in people with dementia (Gibson, 1994).

An example from practice

Click on the link below to read about a project (Gibson 1994) applying reminiscence work.

The project:

Find out more

If you are interested in finding out more about different kinds of reminiscence and reminiscence activity - including visual and performance arts projects, intergenerational projects and objects and artefacts which act as memory triggers - a good place to start is Age Exchange, either in person at The Reminiscence Centre at Blackheath, South-East London, or via the Age Exchange web-site.

It functions as:

  • A national reminiscence training and resource centre
  • The home of a professional reminiscence theatre company
  • A museum of everyday life in the first half of the twentieth century
  • A site for intergenerational and educational activities
  • A local community centre with cultural and social activities
  • A gallery with changing exhibitions
  • The headquarters of the UK and European Reminiscence Networks

There are also publications on reminiscence work.

Page 3 of 3

How can the biographical approach and reminiscence be of practical use in work with older people with mental health issues?

Now you have worked through the sections on the biographical and reminiscence approaches, you will have seen that these approaches can be very beneficial to working with older people:

  • to enable individuals to review their lives
  • to affirm and identity self-esteem
  • to assist communication and influence decisions on the services or care most suited to an individual's needs
  • to help enhance the quality of staff-user interactions